This week, we'd like to introduce you to another type of team member you might see as someone diagnosed with Mild Cognitive Impairment, a geriatrician! Thomas Loepfe, MD, M.Sc. attended medical school, residency, and fellowship training at the Mayo Medical School/Mayo Clinic Graduate School of Medical Education in Rochester, MN. He is a Fellow of the American College of Physicians, and certified by the American Board of Internal Medicine/Geriatrics Hospice and Palliative Medicine.
I work closely with Dr. Loepfe, as many of the patients I see for neuropsychological evaluation also are patients of Dr. Loepfe. I sat down with him to learn more about the role of a geriatrician on the medical team of someone who has MCI.
Q: Tell me a little bit about what it means to be a geriatrician, for those who aren’t familiar with the specialty:
A: A geriatrician is a specialist in the medical care of the elderly. Geriatricians are experts in the processes of growing old. They are trained in the medical, physical, cognitive, psychosocial, and functional changes that come with aging. They assist those patients with multiple chronic and complex medical problems, those on multiple medications, patients needing help with environmental transitions, those that need help defining appropriate goals of care, helping with advance care plans and end of life issues. Geriatrics uses a multidisciplinary team approach to the care of the elderly, especially those elderly that find they are struggling to maintain health and independence.
Q: How did you decide to go into this area?
A: I find aging and the changes with aging, especially the aging brain, to be a fascinating field of science and medicine. During my medical training I found assisting the elderly and their multiple, interconnected complex problems was very challenging, both instinctually as well as psychosocially. I enjoy the multidisciplinary approach geriatric medicine has used since the field was founded many years ago. I found that geriatrics was a perfect fit for me, my interests, my skills, and my personality.
Q: If a patient already has a primary care doctor, what does it add to have them see a geriatrician as well? Would they still see their primary care doctor?
A: The patient needs to maintain a relationship with his/her primary care provider. Sometimes geriatricians will do primary care as well as consultative care. Here at Mayo Clinic Health System-La Crosse, the Dept. of Geriatrics is consultation-based. We assist the primary care team with our expertise on aging and the changes and challenges that come with aging, such as dementia, depression, physical and functional declines, needing more assistance at home, advance care planning, capacity to make their own decisions, connections with governmental services, and so on. We work closely with the primary care provider. The patient still needs a primary care provider. The primary care provider is critical part of the health care team.
Q: Tell me about the Dementia Care Program you run. How do people with Mild Cognitive Impairment (MCI) fit in?
A: As part of our department of geriatrics services, we evaluate memory loss concerns that the patient or their families/caregivers may have. Our Dementia Care Program is a comprehensive, multidisciplinary team approach to the care of our dementia patients. If the patient is diagnosed with dementia, they will become part of our Dementia Care Program. We will look at the whole situation the patient is in, including health status, cognitive abilities, functional abilities, psychosocial needs, quality of life of patient and caregivers, degree of stress in the environment, the need for increased services, and many other aspect of their situation that their dementia impacts. We will follow and assist the patients, their caregivers, and their primary care providers long-term, many times from diagnosis to end of life.
Patients with mild cognitive impairment (MCI) are ideal for our program. The people with MCI have mild memory loss and can benefit from our education and support programs and offerings. The HABIT program offered through Neuropsychology/Behavioral Health has shown to be of significant benefit for the individuals with MCI. We also have a dementia support group on campus which includes both patients and their caregivers and participants find the group very valuable to them.
Q: What’s been the most rewarding part of your career in working with people with memory loss?
A: I think the most rewarding part of working with those with memory loss is extending a hand to help. Many times even the smallest act of helping or of kindness can go the longest way. Plus I truly enjoy the times when a patient with dementia smiles. That smile goes right to my heart.
Q: What advice do you have for caregivers that you wish they would follow?
A: I would say to them to take one day at a time, to ask for help (there is a lot available), and to always try to look at something positive in the situation. Finding humor in the moment can significantly lower the stress levels.
Q: If someone wants to find a geriatrician in their area, how would they go about doing that?
A: There is a significant shortage of geriatricians in the nation so it could be challenging to find a certified geriatrician in any particular region. I would suggest that they ask their primary care provider first. Many times large medical/health care systems will have a geriatrics department or service line. Their websites may be a good place to start. The American Geriatrics Society has a list of some geriatricians on their website. Word-of-mouth from friends and family might be helpful. And of course, there is always Google.
Join other members talking about health and wellbeing as we age at the Aging well support group.