About

About

US News Ranking 2016-17

Cleveland Clinic's Geriatric Medicine program specializes in diagnosing and treating elderly patients with complex medical conditions and social problems.

Our goal is to create comprehensive geriatric care plans designed to preserve independence and improve quality of life for geriatric patients. Dementia care is a significant component of our clinical, teaching, and research efforts.

Center for Geriatric Medicine Provides Specialized, Expert Care for Older Adults

At the Center for Geriatric Medicine, older adults referred for geriatric assessments can be seen by a nurse and physician trained in geriatric problems. Consultations with social services and a geriatric pharmacist also can be coordinated.

We have expanded our geriatric medicine staff, and offer multi-specialty clinics and outreach programs at Cleveland Clinic Health System hospitals and Cleveland Clinic Family Health Centers throughout Northeast Ohio.

Services

Services

Geriatric care is available anywhere to help preserve your independence and maintain your quality of life. A multidisciplinary team of doctors, nurses, therapists, technicians, social workers and other medical professionals collaborate to help you or your loved one achieve the best possible outcome and independence.

Appointments
For more information about geriatric care, or to schedule an appointment, call us locally at 216.444.5665 or toll-free 800.223.2273, ext. 45665.

Our Services
Explore the range of services we offer for geriatric patients, from evaluation to prevention and treatment.

Our Doctors

Our Doctors

Appointments

Appointments

Appointments

To schedule an appointment with the Cleveland Clinic Geriatric Medicine team, call the appointment line at 216.444.5665 or toll-free 800.223.2273, ext. 45665 or request an appointment online

To contact us for all other questions, please call 216.444.6819.

Locations

Directions to Our Offices

Our consultation and examination rooms are located at 10685 Carnegie Avenue, X10, Cleveland, OH, 44106 on Cleveland Clinic main campus.

Special Assistance for Out-of-town Patients

Cleveland Clinic's Medical Concierge program is a complimentary service for patients who travel to Cleveland Clinic from outside Northeast Ohio.

Our patient representatives can help with any additional arrangements including:

  • Schedule multiple medical appointments
  • Provide access to discounts on airline tickets and hotels, when available
  • Make reservations for hotel or housing accommodations
  • Arrange leisure activities.

For more information, call 216.444.2000, ext. 55580 or 800.223.2273, ext. 55580.

Learn More


Second Opinions

Following a thorough review of your medical records and diagnostic tests, our geriatric specialists render a second opinion that can be shared with your doctor.

What We Treat

  • Abnormal weight loss
  • Dementia
  • Dizziness
  • Falls
  • Gait Abnormality
  • Memory Loss

Ronan Factora, MD

Department: Center for Geriatric Medicine
Locations: Cleveland Clinic main campus, Independence Family Health Center
Ronan Mangcucang Factora, MD, is Staff in the Department of General Internal Medicine, Section of Geriatrics and Program Director of the Geriatric Fellowship Training Program at the Cleveland Clinic. He is a diplomate of American Board of Internal Medicine, with added qualifications in geriatric medicine. His clinical interests include Alzheimer’s disease, dementias, functional capacity and pain management.

For Medical Professionals

For Medical Professionals

The Center for Geriatric Medicine consists of an interdisciplinary team of healthcare professionals dedicated to working with you to help you maintain your patient's geriatric care, health and quality of life. We also can provide you with caregiver resources and contact information for reputable disease and condition-related organizations to share with geriatric patients and their families.

Nationally Recognized Geriatric Care

Our expertise in providing comprehensive geriatric care, educational programming and a unique Geriatric Fellowship Program have made Cleveland Clinic's Section of Geriatric Medicine one of the top programs of its kind in the United States.

What is the Center for Geriatric Medicine?

The Center for Geriatric Medicine guides hospitals with their geriatric activities, including protocols for falls and delirium.

Our electronic medical records enable coordination of nursing assessment. Metrics for cognitive and physical function are common to all care sites, which facilitates coordination and improved quality of care throughout the system.

Our geriatric care team includes:

  • Family medicine and internal medicine physicians with specialty certification in geriatrics
  • Psychiatrists and pharmacists with geriatric certification
  • Emergency department specialists who have grants to study geriatric health in that setting
  • Specialists, including cardiologists, gynecologists, urologists, neurologists, neurosurgeons and orthopedists
  • Therapists who specialize in problems common to geriatric patients, such as cognition, swallowing disorders, incontinence, osteoporosis, balance and others.

Why refer your patient to the Center for Geriatric Medicine?

Geriatric care patients present a challenge because of the complexity of their chronic diseases and functional impairments. Their care needs ratchet up significantly when cognitive function is impaired.

The most appropriate diagnoses are not always clear for frail, elderly patients, and choosing among the multitude of treatment options and geriatric care strategies can be daunting. Based on our experience of caring for thousands of older patients, we are able to help determine treatment protocols that consider the interplay of multiple medical conditions, polypharmacy and even socioeconomic factors.

Who should be referred for a geriatric consult or appointment?

Patients may benefit from a Geriatric Medicine consult if they:

  • Are frail, over age 75 and live alone
  • Have multiple health problems and/or take multiple medications to manage chronic conditions
  • Have memory impairments, Alzheimer's disease or are experiencing significant cognitive decline
  • Are experiencing behavioral changes, including sadness, depression or anxiety
  • Have difficulty performing activities of daily living
  • Are experiencing weakness from deconditioning
  • Are experiencing balance and gait problems
  • Have nutritional concerns, including unexplained weight loss
  • Have been hospitalized and require long-term rehabilitation
  • Lack a good support network
  • Require help with end-of-life care decisions

How do I make a referral or appointment?

To make a referral or an appointment for your patient, please call the Cleveland Clinic Appointment Center at 216.444.5665 or 800.223.2272, ext. 45665. You also may call the Center for Geriatric Medicine at 216.444.6819, or 800.223.2273, ext. 46819.

When would a patient benefit from being referred to a geriatrician?

Contact a geriatrician if your patient is experiencing any of the following:

  • If you suspect polypharmacy (when the patient appears to be on too many medications).
  • Has memory impairments, Alzheimer’s disease or is experiencing significant cognitive decline
  • The patient is displaying behavioral problems resulting from cognitive problems
  • If the patient is non-compliant with medications or therapy because of cognitive issues, a letter of capacity may be needed (“expert evaluation”).
  • The patient appears to need a caregiver, but has none or the person in place is inadequate.
  • If the patient is showing signs of depression, sadness or anxiety.
  • The patient has fallen, or the patient has balance or gait problems
  • The patient is experiencing weakness from de-conditioning
  • If you have nutritional concerns, with the patient showing sudden, unexplained weight loss.
  • When there is uncertainty about the goals of care of the patient (aggressive versus comfort and function).
  • When the patient requires help with end-of-life care decisions
  • When there is difficulty performing activities of daily living (ADL).

Our Services and Programs

Our care, services and programs are patient-centered, comprehensive and delivered in a timely, thoughtful manner. Learn more about our services:

Resources

Resources

A geriatric patient is an older person with impaired overall function. There is no set age, but he or she is usually more than 75 years old with chronic illness(es), physical impairment and/or cognitive impairment.

Older adults with frailty may also struggle with the following:

  • Gait abnormalities and recurrent falls
  • Depression
  • Fatigue
  • Cognitive impairment and/or dementia
  • Behaviors associated with dementia
  • Urinary incontinence
  • Reduced strength
  • Low levels of physical activity
  • Weight loss.

The cause is often multifactorial, reflecting the aging immune system, lifestyle choices, comorbidities and the psychosocial setting. Patients and their families note loss of muscle mass, a sense that clothing hangs, low quality diet and reduced level of activity. Frailty places older adults at increased risk of adverse events such as malnutrition, falls, fractures, death, disability and institutionalization.

They also may be prescribed multiple medications and encounter adverse effects from polypharmacy. They may not be making safe decisions for their healthcare, safety or finances. They may be at risk of exploitation, neglect or even abuse.

Aging Resources

Healthy Aging Articles

We can help you determine the caregiver services and programs you need and assist you to secure these services.

Community Services

Housing

We can provide information and suggestions about how to plan for and select appropriate housing to meet your current and future needs.

Home Care

  • You may be able to remain in your own home by making modifications that improve its accessibility and safety. Learn more:
  • You also may benefit from the assistance of a home care or home health aide. Home care aides help with daily activities, such as bathing, meal preparation, and getting to and from a doctor's appointment.

  • Home health aides can also help with needs of geriatric patients such as medication monitoring and simple wound care. Fees for home care are based on hourly rates and vary depending on the level of assistance required.

Continuing Care Retirement Community

  • A continuing care retirement community (CCRC) includes several levels of housing, including assisted living and skilled nursing/long-term care. A CCRC usually guarantees lifelong accommodations and includes access to its own long-term care facility. Residents typically sign a long-term contract or lease and pay a one-time entrance or endowment fee.
  • While Medicare and Medicaid do not cover costs of independent and assisted living housing in a CCRC, the programs usually cover some or all the costs of housing in the CCRC's skilled nursing/long-term care facility.

Assisted Living

  • Designed for frail, older adults, assisted living provides a combination of apartment-style living, socialization activities and personal geriatrics care services, such as meals, medication monitoring, transportation and housekeeping services.
  • Assisted living facilities have professional staff on duty between eight and 24 hours each day, depending on the needs of their residents. Skilled nursing services may be provided on a part-time intermittent basis to assisted living residents, but cannot exceed 120 days in any 12-month period.

  • Fees for assisted living are not covered by Medicare or Medicaid and costs vary. The latest data* indicate a range of between $1,200 and $4,500 per month. The most common method of payment is through a rental agreement that covers rent and basic services. Additional services can be provided at additional cost. (*Supportive Housing for Older Persons, Western Reserve Area Agency on Aging, 2005)

  • Long-term/Skilled Nursing Carean assisted living facility. Such care also can be provided in a skilled nursing facility (nursing home) able to provide skilled nursing and rehabilitation services and/or 24-hour nursing care if needed.

  • Fees for long-term care can be covered through long-term care insurance, private insurance, Medicare and/or Medicare Supplement Insurance (MedSupp/Medigap).

Respite Options

  • If a family member or caregiver needs time away from the responsibilities of caregiving, the following services can provide that much-needed respite for a couple of hours or a couple of days.

  • When you need time away from the responsibilities of caregiving, the following services can provide the break you need – for a couple of hours or even a couple of days.

Adult Day Programs

  • Community-based day care programs, including Euclid Hospital's Neuro Day Hospital Rehabilitation Program, provide services that coordinate your medical needs, rehabilitation needs, and social and emotional needs. These programs can help you remain at home by providing you with regularly scheduled care and your caregiver with time to work and address personal needs.
  • Adult day programs are run by many healthcare and social service organizations. Most programs start around 9 a.m. and end between 3:30 p.m. and 5 p.m.

  • We can help you find a program that will fit your needs, or you can search for programs through ElderLocator or the National Adult Day Services Association. You also may call the association toll-free at 800.558.5301.

Home Respite Programs

  • Trained home care and home health aides or volunteers from Hospice of Cleveland Clinic, other non-profit and for-profit hospices, religious organizations, social service agencies and disease-specific organizations, such as the Alzheimer's Association, are available to come into your home and provide short-term care.

Facility-based Respite Programs

  • Many hospices, nursing homes and assisted living facilities, especially those providing care for people with Alzheimer's disease, have staff and rooms devoted to respite care.

Hospice Care

  • This special kind of assistance offers 24-hour care that emphasizes pain management and quality of life. Hospice of Cleveland Clinic's team, including physician, nurse, counselors, clergy, therapists, aides and volunteers, can provide hospice care as a respite service in your home, in a long-term care facility, or in the hospital.
  • Fees are covered by Medicare, Medicaid and most private insurance plans. For more information about Hospice of Cleveland Clinic, call us locally at 216.444.9819, or toll-free at 800.227-2273, ext. 49819.

Nutrition Options

  • If you don't eat well, you won't be able to maintain your health, strength and ability to carry out daily activities. Besides providing you with an individualized nutrition plan, we also can provide information on:

    • Commercially prepared meals
      Many companies offer prepared or frozen meals that are nutritious, low in sodium and unhealthy fats, easy to prepare in a microwave or toaster oven, and appropriate for a wide range of caloric needs.
    • Community dining programs
      Eating is a social activity: It helps you to maintain both your physical and emotional health. We can provide information on community dining programs and activities offered through local senior centers, religious organizations or social service agencies.
    • Home-delivered meals
      Home-delivered meals can be ordered through local community agencies, such as Meals-on-Wheels, or from for-profit companies that serve the general public.

Transportation Options

  • There are various kinds of transportation services:

    • Curb-to-curb services require you to be able to walk from your home to the curb to enter the vehicle.
    • Door-to-door transportation assists you from your home to your destination.
    • Escort services provide a person to accompany you to medical appointments or while banking or shopping. Some local offices on aging and senior centers also provide the latter service.
  • Good sources for local transportation options include your local office on aging, senior center, community newspaper and Yellow Pages. You or your loved one can find busses, ride-sharing programs and volunteer organizations that provide transportation services to older adults.

  • As part of their service package, many seniors-only apartment buildings and assisted living facilities provide transportation for social activities, shopping, banking and medical appointments.

Community Paratransit Services

  • Most large city and/or regional transportation companies have small busses or vans that can be scheduled for curb-to-curb service. In most cases, the cost of the service is between $1 and $3.

Pay-as-you-go Services

  • Local taxi and transportation companies and licensed, bonded private individuals also provide transportation services. Many are listed in the Ambulance Services or Transportation Services sections of your local Yellow Pages and in the classified section of your community newspaper.

Handicapped Parking Permits

Hanging vehicle tags and special license plates are available from each state's Bureau of Motor Vehicles. 

Legal Assistance

Living Will

Durable Power of Attorney for Healthcare

Do Not Resuscitate Order (DNR)

  • This document expresses your wishes regarding cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating.

Related Content

Community Resources

Below, find agencies, programs, services and support groups.

Many organizations have local chapters; contact information is included.

Please note: This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

Agencies

Programs & Services

Groups

Prescription Discounts

The best source for information on free or low-cost medications is Free and Low Cost Prescription Drugs , published by the Cost Containment Research Institute.

Other resources include:

Education & Enrichment Programs

People 60 and older are invited to attend classes for free, on a space-available basis , at many state-supported colleges and universities. In addition, education and life-enrichment programs are offered at/through:

Assistive Devices, Supplies & Products

The best source for information on medical supplies and devices is the Western Reserve Area on Aging's Older Adults: The Resource Guide . To order a free copy, call 216.621.8010 or place an order online.

Hip Protectors

How We Can Help with Caregiver Services

  • Our multidisciplinary team includes doctors, nurses, therapists, technicians, social workers and other medical professionals who are dedicated to helping your loved one achieve the best possible health outcome, while providing you with the support, information, caregiver services, and tools that you need.

  • If you are the primary caregiver for an older family member, spouse or friend, you have taken on a rewarding, but challenging role. If you begin to experience caregiver stress, you need to seek help to ensure that your own health does not suffer.

Below, read signs and symptoms of caregiver stress:

  • Feelings of resentment, anger, impatience and/or irritability at the care recipient or other family members
  • Feelings of guilt and inadequacy because you believe you aren't doing enough for the care recipient
  • Anxiety from feeling underwhelmed with information and overwhelmed with responsibilities
  • Low energy, fatigue and feelings of mental and physical exhaustion
  • Feelings of apathy, including loss of libido and interest in once-pleasurable activities
  • Mood swings, including feelings of sadness and spontaneous outbreaks of crying
  • Appetite changes that have led to weight loss or gain
  • Insomnia or the inability to get out of bed in the morning
  • Increased family or job stress tied to family-caregiver conflicts
  • Social isolation tied to caregiving responsibilities that consume time, energy and money
  • Increased "self-medication" with tobacco, alcohol, psychoactive medications or illegal drugs
  • Postponed or missed medical and dental appointments.

If you are experiencing such symptoms, you may need advice, guidance and help with your caregiver responsibilities. At Cleveland Clinic, we're here for you. For more information, call us locally at 216.444.5665 or toll-free 800.223.2273, ext. 45665.

How do I get an appointment?

Your physician can refer you to one of our geriatricians.

To make an appointment at either Cleveland Clinic main campus or Independence, please call 216.444.5665. For our Euclid Hospital location, please call 216.692.8876.

If you have any questions for Ronan Factora, MD, call 216.444.8091. If you have questions for Amanda Lathia, MD, call 216.444.0319 and if you have questions for Quratulain Syed, MD call 216.444.5665.

Pamphlets & Brochures

The following brochures may be ordered free from the American Health Care Association by calling 800.321.0343:

  • Caring for Someone with Alzheimer's
  • Consumer's Guide to Assisted Living and Residential Care
  • Consumer's Guide to Nursing Facilities
  • Having a Conversation About Long Term Care
  • Having Your Say: Advance Directives
  • Here's Help: Visiting Friends and Relatives
  • Making the Transition: Nursing Home Life
  • Understanding Long Term Care Insurance

The following brochures may be ordered free or downloaded from the Internet:

Guides

Choosing a Nursing Home

800.638.6833

Help for the Unique Needs of Seniors with Cancer (free)

Cleveland Clinic
800.890.2464

How to Choose a Home Care Provider

202.547.7424
www.nahc.org/consumer-information/right-home-care-provider

Medicare and You

800.633.4227

Older Adults: The Resource Guide

(Cuyahoga, Geauga, Lake, Lorain, Medina counties)
216.621.8010 or 800.626.7277 ext. 120

Senior Living Guide: Cleveland & Northeast Ohio

440.338.5233 (free + s/h)

Shopper's Guide to Life Insurance

Ohio Department of Insurance
800.686.1578
Ohio Department of Insurance

So Far Away: Twenty Questions for Long-Distance Caregivers

National Institute on Aging
800.222.2225
www.nia.nih.gov/HealthInformation/Publications/LongDistanceCaregiving

The Pocket Guide to Good Health for Adults

800.358.9295
www.ahrq.gov/ppip/adguide

Your Guide to Choosing Quality Health Care

800.358.9295
www.ahrq.gov/consumer/qnt

Books

For a complete list of the latest titles available, visit Kaplan Publishing online.

  • Aging in Place: Designing, Adapting, and Enhancing the Home Environment, E.D. Taira, M.P.H., O.T.R. and J.L. Carlson, M.S., O.T.R.
  • Age Well! A Cleveland Clinic Guide, Robert Palmer, M.D., and Eileen Beal, M.A. (November 2006)
  • Arthritis: A Cleveland Clinic Guide, John D. Clough, M.D.
  • Avoiding the Medicaid Trap, Armond Budish
  • Caregiving at Home, William Leahy, M.D.
  • Caring for the Parents Who Cared for You, Kenneth P. Scileppi, M.D.
  • Diabetes: A Cleveland Clinic Guide, S. Sethu Reddy, M.D.
  • ElderCare 911: The Caregiver's Complete Handbook for Making Decisions, Susan Beerman, M.S.W., and Judith Rappaport-Musson, C.S.A.
  • Getting a Good Night's Sleep: A Cleveland Clinic Guide, Nancy Foldvary-Schaefer, D.O.
  • Heart Attack: A Cleveland Clinic Guide, Curtis Rimmerman, M.D.
  • Heart Failure: A Cleveland Clinic Guide, Randall Starling, M.D.
  • Home Planning for Your Later Years, William Wasch
  • How to Care For Aging Parents, Virginia Morris
  • Liver Disorders: A Cleveland Clinic Guide, Nizar Zein, M.D.
  • Merck Manual of Geriatrics, Mark H. Beers, M.D., editor; available free online.
  • One Stroke, Two Survivors, Berenice and Herb Kleiman
  • Osteoporosis: A Cleveland Clinic Guide, Abby Abelson, M.D.
  • Pain Management: A Cleveland Clinic Guide, Michael Stanton-Hicks, M.D.
  • Primary Care: A Cleveland Clinic Guide for Partnering With Your Family Doctor, Vance M. Brown, M.D.
  • Prostate Cancer: A Cleveland Clinic Guide, Eric Klein, M.D.
  • Residential Remodeling and Universal Design 
  • Self-Care for Caregivers, Pat Samples, Diane Larsen, Marvin Larsen
  • Share the Care: How to Organize a Group to Care for Someone Who is Seriously Ill, Cappy Capossela and Sheila Warnock
  • Stedman's Medical Dictionary (28th Edition)
  • Successful Aging, John Rowe, M.D., and Robert Kahn, Ph.D.
  • Taking Care of Mom, Taking Care of Me, Sima Devorah Schloss
  • The Carebook: A Workbook for Caregiver Peace of Mind, Joyce Beedle, R.N., B.S.N.
  • The Comfort of Home: An illustrated step-by-step guide for caregivers, Paula Derr, R.N., and Maria M. Meyer
  • The New Love and Sex After 60, Robert N. Butler, M.D., and Myrna I. Lewis, Ph.D.
  • The New Male Sexuality, Bernie Zilbergeld
  • The Memory Bible, Gary Small, M.D.
  • The 36-Hour Day, Nancy L. Mace and Peter V. Rabins
  • Understanding Health Care, Richard Saul Wurman
Geriatric Care Resources

Agencies that Rate Quality

Information upon which to base important health care and geriatric care decisions.

Government Health Sites

A-to-Z directories and links to health information of interest to older adults and their caregivers.