Joseph Flaherty, M.D., associate professor in the division of geriatric medicine at Saint Louis University School of Medicine, led the team of geriatricians who developed the suggestions to guide physicians.
"Primary care physicians who treat geriatric patients are faced with medical decisions and have limited time," Flaherty says. "They could use a guide to help them choose appropriate treatment.
"In addition, clinicians need guidance concerning many different types of patients, not rigid guidelines based solely on age. An approach to patients based on probable life expectancy and function is more applicable and useful than one based exclusively on age."
Flaherty looks at the guidelines, which he calls "Clinical Glidepaths," as a starting point. "It is not a prescription for caring for patients. Rather it is a model of care that is adjusted or modified to the needs and values of each individual patient," he says.
For aviators, a "glide path" is a route marked by a radio beam that pilots can follow to safely land their planes. Air traffic controllers use the glide path to guide pilots to the runway. Ultimately, however, pilots control the landing.
"The term 'glidepath' was chosen to emphasize that physicians, together with their patients, are in control," Flaherty says. "A Clinical Glidepath gives guidance to clinicians based on the standard of care for specific diseases while allowing them to decide with the patient the final course of action."
There are 24 Clinical Glidepaths covering a wide variety of common problems for which older patients see their physicians. One Glidepath is the Health Maintenance Clinical Glidepath. This Glidepath recommends procedures, screenings and tests that doctors should use in caring for four different types of elderly patients -- the robust, frail, moderately demented and those who are at the end of life. "Not all old patients are the same," Flaherty says.
For instance, the Clinical Glidepath recommends older patients from all of the groups receive an annual influenza vaccine. However, it suggests physicians follow different practices in screening the various groups of aging men for testosterone problems -- asking robust and frail men annually, considering annual screening of moderately demented men and not pursing the issue with those who are at the end of their life.
The Glidepaths were developed by three practicing geriatricians who worked for GeriMed of America, a primary care group that treats older patients. Then the Glidepaths were extensively analyzed and reviewed by Saint Louis University's 10-member university-based geriatrics practice. Their recommendations were scrutinized and revised by two panels consisting of academic and private practice geriatricians, cardiologists, endocrinologists and a urologist.
"The Glidepaths are not a substitute for comprehensive care for older persons, rather they are part of the process. They are not a final answer to all clinical problems faced by geriatric clinicians," Flaherty says. "However they provide peer-reviewed, expert-reviewed guidance and support in many areas for the type of patients they see."
Saint Louis University's division of geriatric medicine is ranked in the top 10 by U.S. News & World Report and its physicians staff Saint Louis University Hospital, ranked by Modern Maturity as one of the 50 best hospitals. Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first M.D. degree west of the Mississippi River. Saint Louis University School of Medicine is a pioneer in geriatric medicine, organ transplantation, chronic disease prevention, cardiovascular disease, neurosciences and vaccine research, among others.
Journal
Journal of the American Geriatrics Society