Director:
Gideon Friedman, MD, Professor of Medicine
The Erna & Henry J. Lier Chair in Geriatrics and Gerontology

Faculty:
Arie Ben-Yehuda, MD, Associate Professor of Medicine

Clinical Activity
In 1991, the Hadassah Hebrew University Medical Center established a Geriatric Unit, with the generous support of Bessie and Louis Stein of Miami Beach Florida, and other friends for the assessment and care of the frail elderly, headed by Prof. G. Friedman. The Unit, which is unique in Israel, is composed of three elements: an inpatient geriatric consultation team, an outpatient clinic and a research laboratory.
The consultation team is multi-disciplinary, consisting of two physicians - specialists in Internal and Geriatric medicine, fellows in Geriatric Medicine, two nurses, a social worker, a part time physiotherapist, an occupational therapist and a dietitian. The staff consults with other hospital staff when necessary, particularly specialists in Psychiatry and Neurology.
The implementation of the consultative model in a large university hospital was based on the assumption that as the work of the Unit became known in the hospital it would exert its influence on the staff, thereby improving the care of the elderly patients.
The staff of the unit was expected to reach as many elderly patients as possible. Unlike most such units elsewhere in the world, which rely only on referrals, Hadassah's Geriatric Unit initiates contact with most elderly patients in the hospital. The skilled multidisciplinary professional staff of the Unit assesses the medical, functional, social, cognitive and mental needs of elderly patients (mainly aged 75 and over), and then formulates a program of care to meet these needs. The actual consultation work process may be divided into four stages:

1. Identification of patients: the staff is automatically informed of the admission of elderly patients (aged 75 and over) to the hospital
   
   
2. Screening: using a structured questionnaire, the staff gathers information about the patients' demographic, medical , nursing, functional and social situation.
   
   
3. Geriatric assessment: based on the above screening, the staff makes a full or partial geriatric assessment using a battery of standard tests and questionnaires.
   
   
4. Summary and recommendations: recommendations on further medical, nursing, functional and social care are made verbally and in writing to the staff at the ward. In addition, a summary letter and recommendations are given to the patient and sent to his family practitioner.
   
   

The Geriatric Unit operates an Outpatient Clinic once a week. The patients coming to the Clinic are referred for functional evaluation by the physicians in the community, or need follow-up or consultations. The work in the Outpatients Clinic is similar to that in the Inpatient Departments: the entire Geriatric Team examines the patients and the recommendations are given accordingly.

Geriatric Grand Rounds
Once a week, every Tuesday from 14:30 - 16:00, the Geriatric Team convenes and together with other colleagues from the hospital, and physicians from the community, discusses patients with special problems that were diagnosed during their hospitalization, or were seen in the outpatient clinic.

Academic Activities
The Geriatric Unit participates actively in the teaching at the hospital, the Nursing School and the Hadassah - Hebrew University School of Medicine.

1. The team is involved in the course in Geriatrics to nurses in the framework of the advanced nurses courses.
   
   
2. The Geriatric Team participates in the clinical teaching of fourth and sixth year medical students. In addition the team gives lectures in the community.
   
   
3. In December 1994, the Geriatric Unit established a residency program in Geriatrics. So far ten residents entered the program. The purpose of this residency program is to create academic geriatric specialists who will become leaders in their field and give an impetus to geriatrics in Israel.
   
   
4. In an attempt to bridge the gap between the rising needs of the frail elderly in a hospital setting and the lack of specially trained health professionals, we designed a comprehensive multi-disciplinary gerontology/geriatrics course for hospital professsionals based on the bio-psycho-social model. Since 1995 we have held four 60-hour courses with a total of over 100 people attending.
   
   
5. Conferences on Aging
   
   
   1. The Bessie and Louis Stein International Geriatric Confrence on Aging in the Mediterranean and the Middle East, chaired and organised by Prof G. Friedman, was held in Tel Aviv September 1996, June 1998, October 2000. The conference brought together individuals from many countries in the area, seeking peaceful scientific exchange on problems facing the elderly. Following the success of this conference, future conferences will be held every two years.
      
      
   2. The Ridgefield foundation international conferences on advances in aging research held in Venthone Swiss / Ridgefield USA 1996, 1997. Conducted under the auspices of Hadassah Medical Organization and Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston USA. Chaired and organized by Prof. I. Rosenberg and Prof. G. Friedman.

    

Research Activity:

Our Research interests are Aging and Atherosclerosis using methods of molecular biology and biochemistry.
Main research topics are:

• Expression of Apolipoprotein E in patients with Alzheimer's disease, and traumatic brain injury.
  
• Improved efficiency of the Influenza Vaccine in the elderly.
  
• Expression of RAG-1 gene with aging.
  
• Effects of growth factors on the regulation of Lipoprotein lipase in vivo and in cell culture.
  
• Activity and expression of the Macrophage Scavenger Receptor and Apolipoprotein E in the elderly.
  
• Dehydroepiandrosterone (DHEA) and aging.
  
• Hyperhomocysteinemia, mutation in the gene for MTHFR as a risk for the development of cardiovascular disease and vascular dementia.

Special Projects

Elder abuse/elder mistreatment program
The geriatric assessment team has acquired a solid base of specific knowledge and experience in the assessment and treatment of elderly adults at risk for mistreatment, while living at home or in institutional care.
This team collaborates with health care professionals in the hospital and in the community to detect, assess and intervene in cases were elderly patients are mistreated.
We give lectures on the subject to health practitioners and students from the different disciplines (nursing, social work and physicians).
In cooperation with the Rambam Hospital in Haifa we received funding for a research project on the theories for the origin of elder mistreatment and characteristics of the abuser and the elderly at risk.