As part of our “Meet Yale Internal Medicine” series, today’s featured faculty is Marcia Mecca, MD, assistant professor of medicine (geriatrics).
For Marcia Mecca, MD, revolutionizing geriatric care means getting at the core of one of its systemic issues: access.
“We never train enough geriatricians each year to make sure that every person who's over 65 has one,” said Mecca, assistant professor of medicine (geriatrics); and co-vice chief for diversity, equity, and inclusion (geriatrics). “What is key is helping to provide education for trainees who will be involved in the care of older adults, no matter what area they go into. So that's been my passion—education and helping to instill important principles about the care of older patients in trainees, regardless of what specialty choice.”
Watching her grandparents navigate geriatric care piqued Mecca’s interest in the specialty and continues to influence her work. “One day, my grandmother told me she doesn’t take her medications on Sundays because she wanted to go to church and her medication doesn’t make her feel well,” said Mecca. “This was before I knew what polypharmacy was. I just thought, ‘There’s something wrong here. Medicine should help you function. You shouldn’t have such adverse drug effects that you have to skip pills on the days you need to get things done.’"
Now, Mecca directs the IMPROVE Polypharmacy Clinic as part of the Veteran Affairs (VA) Connecticut Healthcare System Center of Education for Interprofessional Primary Care. “We have tended to focus on older patients who are taking 10 or more medications,” said Mecca. “Educationally, the goal is to help the residents taking care of patients in that clinic understand what polypharmacy is, how it impacts patients, what the various contributors to the problem are, and what we can do to make it better. Having residents participate in that clinic helps them to gain the skills needed to take care of complex older adults in primary care.”
Mecca says the resident feedback from this clinic has been positive. “They have said that they see changes in the care they are able to offer older patients outside of the IMPROVE clinic,” said Mecca. “So that's really exciting to me, that trainees feel the educational interventions we're working on are impactful.”
Looking forward, Mecca wants to examine how to better treat older patients with pain. “We know that pain is something that can really impact someone's quality of life,” said Mecca.
“But the medications we have still have many adverse effects in older adults, which makes pain management more complex. It is interesting to think about how we can best approach that and teach trainees so they feel prepared to take care of complex patients who may have addiction issues, substance use issues, cognitive issues, or all of the above. We've studied polypharmacy more broadly, but to look into that particular area, polypharmacy and patients who have chronic pain, is an area of future work.”
Mecca has also been working with a national network of colleagues to explore how best to implement and teach Patient Priorities Care. “Dr. [Mary] Tinetti, started this effort and it is exciting to see it expand and to consider the best pedagogical approaches for different learners and settings,” said Mecca. “The goal is to help older adults identify what their healthcare priorities are, and then ensure that the care plans we're recommending to patients are in line with those priorities and goals.” Mecca says Patient Priorities Care is an effective tool that aids patients and clinicians in achieving what matters most to patients. “It’s a shift in the approach to patient care, especially for older adults with multiple chronic conditions. It takes some time to master, but it is so rewarding to experience that ‘aha’ moment with learners.”
Mecca has also recently been named co-vice-chief for diversity, equity and inclusion for the Section of Geriatrics. “I'm looking forward to developing work, in conjunction with Dr. [Inginia] Genao and the other vice-chiefs from other sections within the department,” said Mecca. “We strive to build a diverse, equitable learning environment where all feel included and supported to succeed doing the work that they love.”
Yale’s Section of Geriatrics strives to improve the health of older adults by providing exceptional patient care, training future leaders and innovators in aging, and engaging in cutting-edge research. To learn more about their mission, visit Geriatrics.