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In This Issue:
A 75-year-old woman falls at home. Hurting and anxious, she’s admitted to the BWH Orthopedic Trauma Service with a hip fracture—a common problem in elders.
While the family wonders what went wrong, Houman Javedan, MD, searches for clues. As the service’s first full-time geriatrician, he assesses the woman’s physical, mental and emotional condition, confers with the team and helps the patient with her recovery after surgery.
Broken bones often are not isolated incidents, but symptoms of problems aggravated by growing older, according to Javedan. “Aging is a highly complicated but natural part of life,” he said. “Our physiological systems lose their reserve over time, and challenges like falls and disease occur. And the aging process is different for everyone.”
Since joining the Orthopedic Trauma Service in September through a new clinical partnership with the BWH Division of Aging, Javedan has become a valued colleague to the physicians, nurses, therapists, case managers and other providers. For example, he helped develop age-based medication orders for post-surgical care, since older patients metabolize drugs differently than younger ones.
“He has helped us elevate our practice,” said Mary Anne Murphy Kenyon, MPH, MS, RN, ONC, nursing director of Tower 16AB. “He collaborates with the nursing staff to ensure that the plan of care addresses the individual needs of each patient. He is a role model for patient-family-centered care, as he demonstrates the power of being present and listening to patient and family concerns.”
The program, which is supported in part by the nonprofit organization RxFoundation, grew out of a need identified by the Orthopedic Trauma Service, which recognized that nearly 40 percent of its patients were 70 and older. This led to conversations between the respective division chiefs: Mitchel Harris, MD, of the trauma service, and Juergen Bludau, MD, of the Division of Aging.
Javedan seemed an ideal choice for the role because of his training in both geriatrics and surgery, his strong teaching skills, and his calm, diplomatic style.
“Houman has been an incredible addition to our service,” Harris said. “His understanding of the importance of operating early to ideally restore pre-injury activity level, along with his geriatric medicine expertise, has been a perfect recipe for optimal geriatric fracture care. His daily interactions with the orthopedic anesthesiologists, the hospitalist service, and our residents have clearly raised the quality of care provided for these patients.”
Javedan added, “This truly is interdisciplinary. You need a village to take care of your older patients.”
Javedan sees every patient 70 and older on the service. He performs an internal medicine exam and a geriatric assessment to identify common syndromes such as dementia, urinary incontinence, frailty and social isolation. Sometimes, he watches patients for long stretches to understand why they’re distressed. And when surgery seems futile, Javedan has end-of-life conversations with patients and their families.
“Geriatricians have to be good at both the science and social elements of medicine,” he noted. “You have no choice.”
Data is still being collected, but Bludau hopes other BWH services will consider this multidisciplinary approach of incorporating a geriatrician, especially given the nation’s aging population. There’s currently a similar but smaller collaboration in which Jane Driver, MD, MPH, of the Division of Aging, offers a clinic at Dana-Farber Cancer Institute.
Javedan, who grew up in Ecuador after fleeing religious persecution (he is Baha’i), graduated from Harvard College and then medical school at the University of Edinburgh in Scotland – which he credits with building his bedside skills – before returning to Harvard to complete his training in internal medicine and geriatrics.
“I believe in the nobility of the human condition,” Javedan reflected. “I feel blessed to be able to help older people through this stage of their lives and, hopefully, help the family as well. This work humbles you.”