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Services for Patients & Caregivers

 

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.

Geriatric Evaluation & Management: For Assistance with Multiple Known and Unknown Medical and Social Issues

What is a geriatric evaluation and management assessment?

A geriatric evaluation and management (GEM) assessment is a consultative resource for patients, their family members and caregivers, and their primary care physicians.

The assessment provides a comprehensive assessment of your loved one’s health issues in the context of social and family needs, and it provides a comprehensive plan for managing the person’s conditions and care.

A geriatric evaluation assessment also provides education and patient-specific information about health problems as well as information about and access to community and private supports for patients and caregivers.

When is a geriatric evaluation and management assessment appropriate?

A geriatric evaluation and management assessment is advised if you are concerned about your loved one's ability to live independently or if the person is experiencing any combination of the following symptoms:

  • Multiple health problems
  • Confusion or memory loss
  • Behavioral changes, including sadness, depression or anxiety
  • Difficulty performing daily activities
  • Balance and walking problems
  • Weakness, caused by deconditioning of the muscles or other health problems
  • Nutritional concerns, including unexplained weight loss
  • Problems related to the use of multiple medications, including dizziness or falls
  • Uncertainty about the person's ability to live independently.
What should I or my loved one bring to a geriatric evaluation and management assessment?

For the initial geriatric evaluation and management appointment, bring:

  • All medicine containers
  • Medical records for care obtained outside Cleveland Clinic's system of hospitals and family health centers
  • Details of past illnesses, surgeries, allergies, etc.
  • Current insurance information
  • There is no need for a patient to refrain from eating, but please plan to arrive 30 minutes early.
What should I or my loved one expect during a geriatric evaluation and management assessment?

An initial GEM assessment may last two hours or more. During the assessment, Cleveland Clinic geriatricians will work closely with a team of healthcare professionals - including clinical nurse specialists, social workers, physical therapists and pharmacists - to complete a comprehensive evaluation. Laboratory, X-ray/imaging studies and other referrals will be made as needed.

Using a holistic approach, the Cleveland Clinic team will evaluate and assess the patient's physical health, mental health, functional status, social support system, economic status, as well as the accessibility and safety of the person's living environment. During the assessment, the clinical nurse specialist will assess the person's levels of social and emotional support and physical functioning, which involves the ability to carry out daily activities. The nurse also will screen the patient for depression and memory impairment and gather information about social supports and living conditions.

When the initial GEM assessment is completed, the geriatrician will:

  • Review the medical evaluation with you and your loved one
  • Suggest referrals to other specialists as needed
  • Schedule an appointment for a follow-up visit.
What should I or my loved one expect at the follow-up for the geriatric evaluation and management visit?

At your follow-up visit, the physician will present a full medical, psychological and social evaluation that provides:

  • A clearer understanding of your loved one's health problems and psychological issues
  • A full and comprehensive assessment of the person's needs
  • A plan of care to optimize the person's medical treatments, functioning and quality of life
  • A list of options to consider regarding the person's health issues
  • Advise and help with difficult decisions regarding living arrangements, home safety and end-of-life issues
  • Information and Referrals for all appropriate services and programs services
  • This information will also be provided to your loved one's primary care or referring physician.

During your follow-up visit, arrangements can be made for ongoing GEM consultations to help deal with issues that tend to require ongoing review, such as living arrangements, caregiver needs, health insurance and legal issues and even caregiver needs.

What is the cost of a geriatric evaluation and management assessment?

Costs of the physician consultation are covered by Medicare Part B and most private insurance plans. Costs of diagnostic tests and referrals to team members also are covered by Medicare Part B and most private insurance plans. Specialists may bill separately, but referrals for additional services will be reviewed with you before they are ordered.

How do I make an appointment for geriatric evaluation and management assessment?

You may make an appointment yourself, or the patient's physician may refer the person for evaluation. In addition, the GEM program also accepts referrals from community healthcare providers, including local offices on aging and senior centers.

To make an appointment, please call:

  • Cleveland Clinic: 216.444.5665 or toll-free 800.223.2273, ext. 45665
  • Euclid Hospital/Cleveland Clinic Health System: 216.692.8876
  • Cleveland Clinic Beachwood Family Health Center: 216.839.3000
  • Cleveland Clinic Chestnut Commons, Elyria Family Health Center: 440.366.9444
  • Cleveland Clinic Lorain Family Health Center: 440.204.7400

Geriatric Consult: For Assistance with a Known Medical or Social Issue

If you are caring for a loved one, relative or friend with a specific medical issue, a geriatric consult may be beneficial.

What is a geriatric consult?

A geriatric consult is a scheduled appointment with a geriatrician (and other members of the Geriatric Medicine team as needed). In some ways, a geriatric consult is similar to a Geriatric Evaluation and Management (GEM) assessment, except a consult focuses on a specific situation or medical condition.

For example, you may seek a consult if your loved one needs a comprehensive discharge and recovery plan after emergency surgery or is dealing with health complications related to malnutrition. In the first instance, the consult would be with a Cleveland Clinic geriatrician and social worker/discharge planner; in the second, it would be with one of our geriatricians and/or a diet and nutrition consultant. All records, test results and suggestions generated during a geriatric consult are shared with the patient's primary care physician.

While a geriatric consult focuses on a specific situation or condition, it is "like a GEM assessment" a holistic consult that draws upon the expertise of Cleveland Clinic's entire geriatric team, as needed. During and after a geriatric consult, team members will work closely with you and your loved one's primary care physician to coordinate care.

The geriatric consult team includes some or all of the following:

  • Geriatrician
  • Certified nurse practitioner
  • Social worker
  • Nutritionist
  • Rehabilitation therapist
  • Consulting pharmacist
  • Geropsychiatrist
When is a geriatric consult advised?

Geriatric consults are strongly advised if the patient's primary care physician would like outside expertise to help evaluate and coordinate care for a specific age-related condition, or if the patient:

  • Is frail, over age 75 and lives alone
  • Is taking multiple medications to manage chronic health conditions
  • Has impaired heart, kidney, liver and/or lung function
  • Has memory impairments, Alzheimer's disease, or is experiencing significant cognitive decline
  • Is depressed
  • Has been hospitalized and will require long-term rehabilitation
  • Lacks a good support network
  • Requires help with end-of-life care and/or decisions
  • Consults also are advised if the patient has experienced a medical emergency, such as a stroke or fall that results in hospitalization; has undergone stressful treatments or surgery; or is transitioning to a new age-stage or living environment.
What is the cost of a geriatric consult?

Costs of a geriatric consultation usually are covered by Medicare Part B. Many private insurance companies also cover some or all of the costs. Costs of diagnostic tests and referrals to consult team members are covered by Medicare Part B and by many private insurance companies. Specialists may bill separately, but referrals for their services will be reviewed with you and your loved one before the services are ordered.

How do I or a loved one make an appointment for a geriatric consult?

As the person's primary caregiver, you may make an appointment for a geriatric consult. The patient's primary care physician also may refer the person. If the person is in the hospital, the hospitalist (attending physician) may schedule an appointment. In addition, the Geriatric Medicine team accepts referrals from community health care providers, including local offices on aging and senior centers.

To make an appointment, call 216.444.5665 or toll-free 800.223.2273, ext. 45665.

Geriatric Falls Clinic: For Evaluation and Follow-up for the Treatment and Prevention of Falls

The Geriatric Falls Clinic involves a multidisciplinary assessment, including screening of vision, medical conditions, polypharmacy, nutritional status, mental alertness, physical function, balance and strength.

After the assessment, a summary letter will be provided to the patient and physician. The Falls Clinic is advised for any elderly patient who has had a fall or fracture, has balance problems, or is at high risk for falls.

Before the Appointment

The patient should plan to arrive 15 minutes early and wear comfortable shoes. The patient will meet separately with a nurse practitioner and a physical therapist. The appointment will last about 90 minutes.

The patient should bring the following to the evaluation:

  • All medicine in original containers, including over-the-counter medicines
  • Medical records for care obtained outside the Cleveland Clinic’s hospitals and family health centers (including results of bone mineral density tests)
  • Lab tests from the past two years
  • Details of past falls, prior evaluations, illnesses, surgeries and allergies
  • Current insurance information
Evaluating Patients

Clinical nurse specialist Anne Vanderbilt, MSN, CNS, CNP, will talk with the patient about health issues, nutrition and living environment as related to falls, evaluating for the following:

  • Depression
  • Malnutrition
  • Cognition
  • Vision
  • Osteoporosis
  • Medical conditions
  • Neurological issues
  • Multiple medications
  • Safe living environment

A physical therapist will assess the patient’s physical function, balance and strength and, if appropriate, recommend a physical therapy program tailored to the patient’s needs. The patient can go to any Cleveland Clinic facility to carry out this program. The team will generate a summary of recommendations for the patient and primary care provider and facilitate testing and referrals to other specialists if needed. A follow-up appointment typically is requested in six weeks.

Scheduling an Appointment

To schedule an appointment, please call 216.444.5665 or 800.223.2273, ext. 45665.

Center for Brain Health: For Assistance with Memory-related Issues

As people age, they expect to "slow down" a little. But if your loved one is experiencing severe symptoms of aging – difficulty with balance and walking, tremors, impaired thinking, memory issues or urinary incontinence – an evaluation by team of specialists in the Brain Health Clinic may be able to offer strategies, medications or treatments to help deal with such conditions. The earlier a problem is diagnosed and treated, the better the chance for a successful outcome.

The primary assessment and evaluation team includes physicians who specialize in geriatric medicine, neurology and neurosurgery. Experts in other medical specialties, such as urology and cardiology, as well as professionals in social work, nutrition, psychiatry and neuropsychology also may be on the team.

What should I or a loved one expect during an appointment?

Based on the patient's symptoms, concerns and health history, the person will be scheduled to see the most appropriate specialist within the Brain Health Clinic. Because a series of evaluations and tests will be done, you should plan to spend the entire day at the Brain Health Clinic.

When you arrive, you and your loved one will need to complete a screening questionnaire, and the patient's medical history will be taken by a nurse practitioner. Next, the person will undergo a comprehensive evaluation to detect conditions associated with aging, such as multiple-medication use, cerebrovascular disease, and chemical or metabolic disorders. All of these can mimic the symptoms of memory impairment, dementia, and Alzheimer's or Parkinson's disease. If required, laboratory, imaging and/or other diagnostic tests will be done at this time.

At the conclusion of the assessment, you and your loved one will be presented with a diagnosis and, where appropriate, treatment options. Using the leading-edge technology and therapies available at Cleveland Clinic, many conditions are highly treatable.

Some of these conditions include:

  • Normal Pressure Hydrocephalus (NPH): This is the most treatable form of dementia. The main symptoms of normal pressure hydrocephalus (NPH) - difficulty walking, mild dementia and impaired bladder control - so closely resemble those of other age-related diseases that patients with normal pressure hydrocephalus often are misdiagnosed. Treatment for normal pressure hydrocephalus (NPH) involves the surgical implantation of a shunt (drainage tube), which diverts excess fluid from the brain or spinal canal to another part of the body, where it is safely absorbed. Cleveland Clinic neurosurgeons use an improved method of implantation, which has resulted in better outcomes and fewer complications in normal pressure hydrocephalus (NPH) treatment.
  • Cerebrovascular Disease: Traditionally, cerebrovascular disease which includes cerebral atherosclerosis (hardening of the arteries), stroke and stroke-related conditions - has been treated with open surgery. Today, several minimally invasive treatment options are available, including stent technology.
  • Alzheimer's Disease/Dementia: Dementia comes in many forms, the most common of which is Alzheimer's disease. If Alzheimer's is suspected, Alzheimer's treatment will include medications to enhance memory function and behavior, and/or medicine to help control symptoms.
  • Movement Disorders/Parkinson's Disease: Parkinson's disease and essential tremor are progressive neurological movement disorders. While there is no cure for these disorders, patients may be helped with medications or a pacemaker-like device that delivers mild, electrical stimulation to block the brain signals that cause tremors.
What is the cost of a Brain Health consult?

Costs of the consultation usually are covered by Medicare Part B. Many private insurance companies also cover some or all of the costs. Costs of diagnostic tests and referrals to consult team members are covered by Medicare Part B and by many private insurance companies. Specialists may bill separately, but referrals for their services will be reviewed with you and your loved one before the services are ordered.

How do I make an appointment for a Brain Health Consult?

To make an appointment at the Center for Brain Health, please call 216.444.5665 or toll-free 800.223.2273, ext. 45665.

How do I or a loved one participate in a clinical trial?

Many clinical trials focus on diseases associated with aging, cerebrovascular disease and movement disorders. For information about clinical trial participation, please speak with your loved one's physician or the Brain Health's geriatrician, Dr. Ronan Factora.

Geriatric Oncology Clinic: For Assistance with Issues Related to Cancer Treatment

If your loved one is 60 or over and has been diagnosed with cancer, the person may benefit from a specialized assessment at the Taussig Cancer Center's Geriatric Oncology Clinic. This assessment is designed to identify and manage problems related to cancer that otherwise may get overlooked. The goal is not just to improve the patient's quality of life, but also to empower the person's family and caregivers to make informed health care decisions.

When could a geriatric oncology clinic assessment help?

A geriatric oncology assessment may help if your loved one is experiencing severe side effects from standard cancer treatment, including confusion, extreme weight loss, breathing or swallowing difficulties, as well as two or more of the following:

  • Multiple health problems and/or issues resulting from the use of multiple medications
  • Behavioral changes, including depression or anxiety
  • Difficulty performing daily activities
  • Physical weakness, frailty
  • Difficulty living independently, functional decline
  • Difficulty with walking or balance
  • Urinary incontinence
  • Osteoporosis or osteoarthritis
  • The potential need for nursing home placement
What can I or a loved one expect during an assessment?

A geriatric oncology assessment may last two hours or more. During the assessment, a specially trained geriatrician will complete a thorough evaluation of the person's health issues and living situation, paying special attention to social and family circumstances. Following the assessment, the physician will provide you and your loved one with a written report summarizing the findings and recommendations. The physician also will also discuss an individualized plan of care.

Recommendations may include consulting with other health care professionals, including a psychologist or psychiatrist, pain management specialist, palliative medicine specialist, social worker, nutritionist, pharmacist, and physical and/or occupational therapist.

In addition, the physician will provide written materials and information about the patient's health issues and concerns, along with information on community and private agencies and support groups associated with the cancer diagnosis. If you wish, the physician also will provide a full report to the patient's primary care physician (PCP) and oncologist.

What is the cost of an Oncology Clinic consult?

Costs of a geriatric oncology assessment typically are covered by Medicaid and Medicare and by most major health insurance plans. Call the insurance plan for specific requirements and/or co-pay information.

How do I or a loved one schedule an appointment for an Oncology Clinic consult?

To schedule an appointment, please call 216.444.7923 or toll-free 866.223.8100.

Useful Websites

A Coordinated Approach for Evaluation and Treatment

At Cleveland Clinic's Aging Brain Clinic, patients have access to medical specialists who work together to evaluate, diagnose and offer treatment options for complex, age-related conditions and brain diseases.

The primary medical team includes physicians who specialize in geriatric medicine, neurology and neurosurgery. Experts in other medical specialties, such as urology and vascular medicine, as well as professionals in social work, nutrition, psychiatry and neuropsychology, are involved as needed.

Patients undergo a comprehensive evaluation, which may include laboratory tests and diagnostic imaging, to detect subtle problems - even difficult-to-diagnose conditions - associated with aging or illness. For example, some patients suffer symptoms related to the mix of medications they take. Some older adults demonstrate dementia-like symptoms due to cerebrovascular disease.

Chemical or metabolic disorders, such as hypothyroidism or vitamin B12 deficiency, may cause dementia-like symptoms. Still others have symptoms that mimic those of dementia, Alzheimer's or Parkinson's disease when, in reality, they suffer from a relatively unknown brain condition called adult onset normal pressure hydrocephalus or NPH.

Many Brain Conditions are Treatable

Because many older adults have complex symptoms or conditions that are difficult to diagnose, too often they go untreated. Yet many conditions including conditions of an aging brain--are highly treatable using leading-edge technology and therapies available at Cleveland Clinic.

Some of these brain conditions include:

Cerebrovascular Disease

Traditionally, cerebrovascular disease, which includes carotid and cerebral atherosclerosis, intracranial aneurysms, stroke and stroke-related conditions, has been treated only with open surgery. Today, several minimally invasive, endovascular treatment options are available, including stent technology.

Alzheimer's Disease/Dementia

Dementia, characterized by a severe decline in cognitive function, comes in many forms, the most common of which is Alzheimer's disease. If a diagnosis of probable or possible Alzheimer's disease can be made, treatment
may include medications to enhance memory function and behavior, or palliative medicine and therapy to help control symptoms and improve quality of life for this common devastating disease of the aging brain .

Movement Disorders/Parkinson's Disease

Essential tremor and Parkinson's disease are progressive neurological movement disorders. Although there is no cure for these movement disorders, patients may be helped with medications or an FDA-approved pacemaker-like device that delivers mild, electrical stimulation to block the brain signals that cause tremors.

Normal Pressure Hydrocephalus

The three main symptoms of NPH - difficulty walking, mild dementia and impaired bladder control - so closely resemble those of other age-related diseases, patients often are misdiagnosed. Treatment involves the surgical implantation of a shunt, which diverts the excess cerebrospinal fluid from the brain or spinal canal to another part of the body where the fluid is easily and safely absorbed. Neurosurgeons at Cleveland Clinic use an improved method of implantation, which has resulted in better outcomes and fewer complications.

Typical Visit

Based on the brain symptoms, concerns and health history, a patient is scheduled to see the most appropriate specialist within the Aging Brain Clinic. You will need to hand-carry all of your records and brain imaging films with you to your appointment. When a patient first arrives, he or she completes a screening questionnaire and is interviewed by a nurse. Next, a medical specialist evaluates the patient. Any necessary laboratory, imaging or other diagnostic testing for referrals to other specialty services at Cleveland Clinic. The team sends reports to the patient's primary care physician when requested.

Although our schedulers will do their best to make sure waiting time is kept to a minimum, patients should plan to spend the entire day at the Aging Brain Clinic. The goal is to provide a comprehensive assessment and treatment plan in a convenient manner for patients and their families.

Leading Edge Research

More than 100 neuroscience clinical research trials are currently under way at Cleveland Clinic, many of which involve cerebrovascular disease, movement disorders and diseases associated with aging brains and bodies. Clinical and experimental studies involve investigation of disease and new modes of diagnosis and treatment.

Help Is Available

Oftentimes serious symptoms in older adults are overlooked or accepted as part of the normal aging process. This isn't always true. Help is often available, and the earlier a problem is found, the better the chance for a successful outcome.

Understanding Health Information

Medical terms and concepts can be confusing. If after your appointment you need additional help understanding the medical information or instructions that were given to you, please ask to speak with a nurse educator. Our team can provide you with information related to a specific illness or disease, diagnostic tests, and medical and surgical treatments. You also can get information on support groups and other community resources that may help you and your family. You may contact our Center directly at 216.444.8091.

Appointments

For an appointment at Cleveland Clinic's Aging Brain Clinic, please call 216.444.5665.

Special Service for Out-of-Town Patients

Cleveland Clinic's Medical Concierge program is a special complimentary service for patients who travel to The Cleveland Clinic from outside Northeast Ohio. Our patient care representatives will facilitate and coordinate the scheduling of multiple medical appointments; provide access to discounts on airline tickets and hotels, when available; make reservations for hotel or housing accommodations; and arrange leisure activities.

 

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