Marilyn S Specialized Primary Care for Older Adults

“Both my husband and I rely on the excellent care at RWJUH Hamilton.”

Marilyn Silverman provides almost a textbook example of what it’s like to have a geriatrician as your primary care doctor.

When she heard that Sara Ali, MD, a geriatric and palliative care specialist and a member of RWJBarnabas Health Medical Group, was coming on board at Robert Wood Johnson University Hospital (RWJUH) Hamilton in 2019, Marilyn became one of Dr. Ali’s first patients. “Being in my 70s, I decided that a physician specializing in seniors was just what the doctor ordered,” Marilyn says with a wink.

Active and in good health, Marilyn mainly saw doctors for routine checkups. As a result, when she did go for an exam, she wanted her primary care physician to take time and be thorough.

Her decision has paid off in ways that exemplify what geriatric medicine is all about. She and Dr. Ali together take steps like these:

Comprehensive Exams

“Dr. Ali gives me a comprehensive annual physical exam and asks a lot of questions,” Marilyn says, “about how my meds are working, what aches and pains I’m having and what issues and concerns I have about my health.”

“Appointments with a geriatrician may be longer than you expect—30 minutes to an hour,” Dr. Ali says. “We take a broad, whole-person view, do a comprehensive analysis and formulate a plan that takes into account the patient’s goals.”

Medication Reviews

“Dr. Ali reviews my medications one by one, assessing whether changes might be needed,” Marilyn says. She credits reduction of a cholesterol medication with relieving nighttime leg cramps.

“We work with a pharmacist to provide maximum benefits with the least amount of medication,” Dr. Ali says. “Many people have long medication lists, but nobody is looking at the whole picture, including drug interactions and side effects.” Polypharmacy reviews can help reduce or eliminate doses, consider other ways to take a drug, track prescriptions and find easier-to-open packaging.

Risk Assessments

“Dr. Ali assesses my cognitive abilities, reviews eyesight and hearing, and even conducted a gait analysis test to assess fall risk and balance,” Marilyn says. “No one had ever done this before.”

“Functional assessments like gait testing can predict a lot, such as falls and future admission to a hospital or a long-term care or skilled nursing facility,” Dr. Ali says. Her assessments also consider potential issues such as memory loss, movement disorders, depression, functional decline and vaccination status.

Continuity Of Care

“When I contracted COVID-19, Dr. Ali arranged for me to have a telehealth visit with her, then sent me to the RWJUH Hamilton Emergency Department for a transfusion of monoclonal antibodies, which knocked out the rather serious effects I was feeling,” Marilyn says.

As a primary care physician, a geriatrician helps patients find specialized care and treatments in other medical disciplines while keeping tabs on the big picture.

Marilyn, for example, has also dealt with an intestinal blockage and a broken wrist, while her husband, Jerry, recently had an emergency appendectomy. “Both my husband and I rely on the excellent care at RWJUH Hamilton,” she says.

Community Engagement

Dr. Ali also works with RWJUH Hamilton’s Better Health Program not only to provide information on topics such as polypharmacy, memory, cognition and prevention of strokes and heart attacks, but also to encourage activity. “Marilyn has a very active lifestyle both physically and socially, which I advocate,” Dr. Ali says. “Social interaction helps cognition, mood and overall well-being. She’s doing very well.”

The Better Health Program is a complimentary membership program for anyone 65+ years old. Rediscover your mind, body and spirit in retirement; meet like-minded adults; and learn from physicians, experts and other professionals who help make members’ well-being a priority.

The 5 Ms Of Geriatric Care Today’s older adults are living longer and healthier lives, but health can change over time as the result of different illnesses, conditions and concerns. Geriatricians take an interdisciplinary approach and focus on five key areas known as the Geriatric 5 Ms: Mind: Working to maintain mental activity; evaluating for and managing dementia and/or cognitive impairment; evaluating and treating depression. Mobility: Maintaining the ability to walk and/or maintain balance, and preventing falls and other types of common injuries. Medications: Ensuring that medications address an older person’s needs and reducing the number of medications when appropriate. Multicomplexity: Helping older adults manage a variety of health conditions and assessing living conditions affected by age, health and social concerns. Matters Most: Helping with managing individual goals of care and ensuring that a person’s health outcomes, goals and care preferences are reflected in treatment plans and advance directives.

Filling A Niche For Elder Care Robert Wood Johnson University Hospital Hamilton is proud to carry the NICHE Designation in recognition of our commitment to patient-centered care for older adults. NICHE stands for Nurses Improving Care for Healthsystem Elders and is the largest geriatric nursing program available. NICHE-designated hospitals recognize specific and unique needs of seniors and understand that patient- and family-centered care is imperative to creating a positive experience and better outcomes for older adults.

To schedule an appointment with Sara Ali, MD, call 609-245-7430. For more information or to schedule an appointment at any RWJBarnabas Health Medical Group primary care location, call 888-724-7123.