With a significant increase in Israel’s elderly population, there is a critical shortage of professionals to attend to their needs. Professor Tzvi Dwolatzky, director, Center for Healthy Aging and director of the Geriatric Unit at Rambam Health Care Campus (Rambam) in Haifa, Israel, outlines the challenges faced by the elderly and discusses a new program designed to improve their lives.
Professor Tzvi Dwolatzky. Photography: Rambam HCC
Advances in medicine and a decreased birth rate are causing a rapid increase in the adult population, particularly the elderly. This situation is affecting every area of life, from urban planning and services to economic development, with healthcare services being the most impacted. Hence, healthcare must evolve to keep up, including geriatric medicine. Professor Tzvi Dwolatzky, explains how the increasing number of elderly residents is contributing to the impending medical crisis in Israel, how providing this demographic group with specialized geriatric hospital care lowers mortality, and who his patients over 100 years of age say about the secret of longevity.
What is the geriatrician’s role?
Geriatrics addresses the medical needs of individuals aged 65 and older. A geriatrician’s understanding of age-related illnesses and body physiology is often deeper than that of an internist, and so their role is significant.
Choosing to specialize in geriatrics
“From a young age, I was fascinated by geriatrics and the unique elements of the third age—65 and older—its complexities, and the patients themselves,” says Dwolatzky. “There are two types of aging: normal aging and suboptimal aging, which involves the gradual loss of senses, such as vision and hearing, as well as physical and cognitive deterioration. This can lead to the loss of the ability to read or communicate with family members.”
Enthralled by geriatric medicine
As the field developed, I was given an opportunity to establish various innovative projects. I established a specialized memory clinic where we treated patients with cognitive decline and Alzheimer’s disease.”
How do the elderly maintain quality of life?
“People are living well into their 80s and 90s—70 is considered young,” Dwolatsky explains. “Often, something small can significantly improve the quality of life for the elderly.” He recalls a time when Israel’s State President invited all citizens over the age of 100 to an event at the official residence. Fearing a medical emergency during the event, they wanted a geriatric specialist in attendance, so Dwolatsky was invited.
Acknowledging the man’s amazing achievement, Dwolatzky shares, “Instead of waiting for the shuttle, a 102-year-old guest walked the distance from the parking lot. When I asked him to share his secret, he answered: ‘I don’t go to doctors, but after my eyesight deteriorated, I finally went. I have authored eight books, and losing my eyesight affected me considerably. My cataract was treated, and it has changed my life.’”
Patients rely on a caregiver from the National Insurance Institute. However, if a specialized multidisciplinary geriatric unit becomes involved, the patient’s future looks brighter. Doctors, nurses, social workers, and others collaborate to address physical rehabilitation, access insurance benefits, and meet social and practical needs, while facilitating open communication with the family. Without this intervention, the outlook can be grim.
Depression is common
“Many geriatric patients suffer from major depression and require intensive treatment and drug therapies,” elaborates Dwolatzky. However, the main issue is a depressive disorder known as ‘dysthymia’—a low-level but persistent depressive state accompanied by feelings of hopelessness and fear of being a burden.
“Antidepressants are often prescribed, but I believe it’s a mistake to rush to medication when a patient first complains. Lifestyle adjustments should be considered before opting for drug intervention. Taking your loved one on outings, discussing the idea of living in a retirement home with medical support—these steps can be crucial. Families play an important role in supporting their older loved ones through these decisions.”
Dwolatzky explains that at age 75, there is a significant turning point—health deteriorates and morbidity increases. However, there are not enough geriatricians in Israel to cope with the aging population. This demographic is increasing at a higher rate than the general population, and the influx of middle-aged immigrants from the former Soviet Union [since the 1980s] has contributed to this trend.
“Currently, there is already a shortage of hospital beds. Without addressing this issue, the healthcare system risks collapse,” Dwolatzky emphasizes. “However, there are estimates that within the next ten years, the increasing morbidity of the elderly will double the need for internal medicine beds.” However, being prepared could change the situation. “Properly planning resources, especially in geriatrics, is crucial to averting such a crisis.”
Getting HELP
Rambam is the only referral center for all of Northern Israel. Dwolatzky has already played a pivotal role in establishing an empathetic geriatric program there that has significantly reduced both mortality and delirium by 75% among hospitalized older patients.
Inspired by a program developed in 1999 by Professor Sharon Inouye at Yale University, Dwolatzky implemented the Hospital Elder Life Program (HELP) at Rambam. This initiative involves volunteers engaging in friendly conversations with patients, encouraging mobility, and promoting good eating habits.
According to Dwolatzky, a study comparing outcomes between participants in the program at Rambam and those who did not participate demonstrated that such simple interventions reduced morbidity by 75%.
A new initiative of the Joint-Eshel association and the Ministry of Health will soon be introduced nationally, in 26 hospitals. The new program, called “Meitav” will seek to specifically address the needs of the elderly population.
“I believe that Meitav will generate positive changes in the geriatric care provided to hospitalized patients. Ultimately, our mission is to deliver professional and compassionate care to those in need,” Dwolatzky concludes.
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