Editor’s note: Dr. Ira Zunin turned over Saturday’s column to Dr. Pia Lorenzo, Manakai o Malama’s newest physician.
The respect and care of our kupuna is a cornerstone of Hawaiian culture. Our kupuna hold the wisdom and knowledge of years gone by and the capacity to teach traditions that will be carried on for generations to come. As people move into their geriatric years, it is vital that we continue to support their independence, humanity and dignity. A coordinated team-based approach to caring for this population makes it possible.
Health care for the geriatric population has shifted over the past 20 years toward a perspective of independence rather than dependence which empowers people to safely remain in their own homes longer. The core issue in geriatric medicine today is that we are working with a population not only with greater longevity, but also with the expectation of maintaining a good quality of life. The challenge arises when patients suffer from multiple chronic medical conditions like diabetes, heart problems, memory issues and chronic pain.
Regardless of one’s state of health, helping to maintain independence represents an increasingly formidable challenge as life spans grow. The complexity of illnesses that accompany advanced age, together with the vast array of treatments available today, are best served by a team-based approach that supports the universal desire for mobility, clarity and freedom.
A multidisciplinary approach begins with the geriatrician. We start the dialogue and build trust with patients by respecting and understanding their personal values, priorities and viewpoints on health and aging. With an understanding of a patient’s perspective, a provider is best able to form a partnership and tailor a plan of care to fulfill specific needs and expectations. This process brings clarity to what health care professionals and patients need to build successful and productive alliance. The providers might include physical therapists, occupational therapists, social workers and psychologists.
Physical therapists provide care that helps to build strength, joint range of motion and balance, and reduce pain. They are experts in musculoskeletal disorders that often cause reduced mobility as we age. The physical therapist proactively educates the patient on how to maintain mobility while reducing risks of injury and chronic pain.
Occupational therapists are the independent-living specialists. They commonly perform home safety evaluations, providing insight into how to make a patient’s home livable and safe despite decreased mobility, sensory functioning and/or impaired cognition. OTs also educate on fall prevention, ergonomics and energy conservation techniques that allow individuals greater independence in the home and community.
Social workers are an invaluable resource when patients have a reduced ability to access community services. They lay out the "road map" to services that will enable individuals to access basic needs despite decreased mobility or community access.
Finally, psychologists are a wonderful resource for helping geriatric patients reduce and manage stress and sometimes depression, and to successfully adjust to declining physical and/or cognitive functioning.
When the elders of our community have open access to robust multidisciplinary, team-based health care, they have the best chance of being well cared for without falling through the cracks. Comprehensive care is essential to promote the independence and the freedom our kupuna deserve.
Dr. Pia Lorenzo is board-certified in internal medicine and geriatrics and spent five years working at Kokua Kalihi and Waianae Coast Comprehensive Health Center. Please submit your questions to info@manakaiomalama.com.
