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A new paradigm for geriatrics

Dean Nancy Brown discusses YSM’s contributions to treating COVID-19 at the epidemic’s peak, and where she sees geriatrics within the school’s overall strategy.

Dean Nancy J. Brown, MD
Photo by Robert A. Lisak
Dean Nancy J. Brown, MD

YSM researchers and clinicians worked hard to diagnose and treat patients with COVID-19, many of whom were older adults. What were some of the school’s successes? One of our earliest success stories was the use of standardized clinical protocols. We updated our protocols regularly and shared them publicly with our own clinicians and those at other institutions. The use of steroids, remdesivir, some of the anti-inflammatory drugs, anticoagulant therapy, how clinicians handled the ventilation of patients, such as “early proning,” or putting a patient into a prone position—these were all innovations that we adopted and shared with others as part of the global fight against the pandemic.

In terms of research, our faculty collected samples from every patient (with their consent), which enabled them to study the immune response to COVID-19, both in terms of favorable and unfavorable responses. Articles are coming out now that detail our faculty’s discoveries, such as those covering abnormal T-cell function associated with age and gender differences among patients.

One breakthrough from the School of Public Health was the recognition that COVID-19 could be detected in wastewater samples. This [finding] can allow investigators to predict an outbreak about a week before the number of positive tests increases. Modeling work has been important as well.

And clinicians in the neurosciences observed that patients who were hospitalized with COVID-19 sometimes had cognitive dysfunction afterward; this had been observed previously in patients hospitalized in the ICU.

What is your assessment of geriatrics at YSM, in terms of research and clinical care? Geriatric medicine has been a traditional area of strength at YSM. Mary Tinetti’s work on falls among older patients has transformed how people think about disease and health in the elderly. Our Yale Claude D. Pepper Older Americans Independence Center (OAIC) is one of 14 such centers in the country, and a home to exciting interdepartmental multidisciplinary collaboration. Ours was established almost three decades ago, and is led by another leader in geriatric medicine at YSM, Thomas Gill.

Given the strength of our basic and clinical neuroscience-related departments, it’s no surprise that healthy aging versus abnormal aging of the brain has been an area of interest. There is much advanced research occurring around neurodegeneration in conditions associated with aging, such as Alzheimer’s disease and disorders such as Parkinsonism. Geriatric depression is another issue where researchers and clinicians are making great strides.

Where is the field of geriatrics today, and where do you see it heading in the future? In a certain sense, all medicine is geriatric medicine. When we treat a cardiac disease or carry out a surgical procedure, it is often in an older person. We understand that diseases in youth affect aging. For that reason, understanding the aging process—something we do not fully know today—is a top priority. Then, why does disease manifest itself differently over a person’s lifetime? Understanding the difference between healthy aging and unhealthy aging will help people take control and influence their quality of life as older adults.

There is also increased curiosity about the concept of frailty, and what causes frailty. Why do some people remain active in old age while others become inactive? There is great variability among individuals, and we need to understand this on a cellular or tissue level. These are all questions the field is wrestling with, but which will be resolved in the future.