Departments

So many of us understand the challenges of caring for a loved one who has a neurodegenerative disease such as Alzheimer’s disease, Parkinson’s disease, or frontotemporal dementia. At our Dorothy Adler Geriatric Assessment Center, our team of experts meets with the patient, family members, or caregivers to determine how medical, psychological, cognitive, or social problems are impeding function or threatening independent living. After assessment, our physicians focus on minimizing the progressive loss of neuron function and repairing neural damage, helping people with these conditions live with as much peace and stability as possible.

We are dedicated to excellence in patient care through the study of the cognitive and behavioral changes that can result from medical and brain injuries. We are experts in identifying a patient’s pattern of cognitive and emotional functioning and how this relates to expected brain function. A neuropsychological evaluation combines tests of cognition, behavior, and emotional functioning. This comprehensive evaluation will help to determine whether cognitive changes are related to symptoms of a medical or neurological illness, a psychological condition, or a normal part of aging. This evaluation is also part of the gold-standard workup for neurosurgery candidates. We provide neuropsychological evaluations for a wide array of medical and neurological disorders, as well as neurosurgery-specific candidacy evaluations. In addition, our bilingual neuropsychologists are able to provide evaluations in Spanish. We have expertise in the following areas. Epilepsy Memory disorders & dementia Multiple Sclerosis Oncology Parkinson’s disease Stroke Traumatic brain injury What to expect at your appointment A neuropsychological evaluation consists of an interview and testing, and lasts approximately three to six hours. During the interview, you will be asked about your cognitive and emotional symptoms, health history and medications, and other important background information. Neuropsychological Testing : Cognitive testing is designed to assess domains of thinking including attention, processing speed, memory, language, visual spatial abilities, and problem solving. Tests include paper-and-pencil as well as computerized methods. Emotional functioning is evaluated during the clinical interview and supplemented with self-report measures. We often request information from a close relation (family member or caregiver) about the individual’s functioning in daily life. The results from testing will aid your providers in diagnosis, treatment planning, and recommendations to improve your overall well-being. The neuropsychological evaluation typically includes administration of standardized tests to determine cognitive functioning in the following areas: General/baseline intellectual ability Attention Processing speed Visuospatial abilities Language Memory Executive functioning (problem solving) Motor skills Behavioral and emotional functioning What to bring to your appointment We are very attentive to our patients’ needs. We work with each patient so that they feel as comfortable as possible. We encourage patents to get a good night’s sleep and eat a good breakfast before the appointment. Please bring the following: Glasses and hearing aids Water and a small snack, if needed Reports from any prior neuropsychological testing previously completed A family member, friend, or caregiver so they can provide insights into your abilities Please call us at 203-785-4085 if you have any questions about your appointment.

We are internationally known for the care we provide for older people, helping them maintain their independence and quality of life, and manage multiple complex health conditions. Our team of geriatricians, geriatric psychiatrists, nurse case managers, patient care assistants, physical therapists, and neuropsychologists works closely with patients, their families, primary care providers, and other care providers to assess and develop a comprehensive plan for their care. Yale physicians have developed widely used interventions and support families facing such challenges as functional decline, disability, decision-making, and driving problems. The Connecticut Older Adult Collaboration for Health 4M (COACH 4M) grant project is pleased to provide an updated and expanded list of available resources and services for older adults in Connecticut, parts of southeastern New York and southwestern Rhode Island. The new user-friendly version enables you to navigate the content through links in the table of contents and region list or using the Adobe bookmark feature. The COACH 4M team hopes you find the Geriatric Resource Directory a helpful guide to assist you in meeting the needs of older adults throughout the region. If you have any questions about the Resource Directory or have corrections to the content, please contact Eliza Kiwak at eliza.kiwak@yale.edu . View the Yale Geriatrics Resource Directory . Disclaimer: COACH 4M does not recommend or endorse the services provided by the organizations and individuals listed in the directory. Inpatient and outpatient geriatric consultations at the VA Connecticut Healthcare System in West Haven Syncope and Falls Assessment Program A prevention initiative for seniors at risk for falls, which has reduced falls and related injuries in many Connecticut The development of the Confusion Assessment Method, used internationally to diagnose delirium An Acute Care for the Elderly Unit at Yale New Haven Hospital, which aids with maintenance of function during acute hospitalization Outpatient consultations at the Dorothy Adler Geriatric Assessment Center

Falls and fall injuries are one of the most common health problems among older adults. However, since falling is not a single disease, clinicians may not recognize falling as a treatable health problem. The consequences of untreated falls and their risk factors can be just as serious as those of other untreated chronic diseases. We have identified risk factors that increase the chance of falling. While some factors that increase risk of falling cannot be changed (such as age and previous falls), there are a number of important ones that can. These include: Any problems with walking or movement Blood pressure dropping too much when getting up (postural hypotension) Use of four or more medications or any psychoactive medications Unsafe footwear or foot problems Visual problems Environmental hazards that can cause tripping Research has shown that treating and correcting these specific health problems reduces the rate of falling by more than 30%. Yale researchers were among the first to show that falls among seniors could be prevented and that fall-prevention interventions mean that seniors are less likely to be hospitalized or need advanced medical care. This research has since been translated into protocols that are used in clinical and community settings to help prevent falls. Falls and fall injuries: Are more common than strokes and can be just as serious in their consequences Are the most preventable cause of needing nursing home placement Lead to problems with daily activities like dressing, bathing, and walking Among adults 70 years and older: Three in 10 fall each year Two in 10 who need home health care after being in the hospital will fall during the first month after coming home One in 10 suffer a serious fall injury such as a broken bone or head injury Five in 10 have problems getting up without help after they have fallen Falls cause over 90% of broken hips; only half of those who break their hip will get around as well as they did before their broken hip In the United States, 16% of all emergency department visits and almost 7% of all hospitalizations are for fall-related injuries

Our center is one of the oldest and most comprehensive geriatric assessment centers in the United States. It began in 1981 when a group of Yale physicians, nurses, and social workers established a geriatric clinic in a corner of Yale New Haven Hospital’s Primary Care Center. One of their first patients was a woman named Dorothy Adler. After her death, her sons decided to support an expanded center to evaluate older adults who struggled to take care of themselves. The center was established in Adler’s name in 1987. In 2009, we moved to a freestanding building across the street from the hospital. Today, we draw patients and families from throughout the state, New York, and New England. Our team includes geriatricians, nurse case managers, and ambulatory care associates. We conduct diagnostic assessments on an outpatient basis at our Yale New Haven Hospital-based clinic or at the patient’s preferred site. Family meetings are held at each visit and include a physician, case manager, family/caregivers, and if appropriate, the patient. We also work closely with the patient’s own doctor. The result is a comprehensive plan to help patients optimize function, independence, and quality of life. We help patients and families develop connections to appropriate community services such as home health care agencies, adult daycare centers, and volunteer support groups. Moreover, in conjunction with the patient’s physician, our staff provides ongoing case management and clinical care, as necessary. Finally, our center serves as an important educational site for interns, residents, and fellows in geriatric medicine. We serve as a model for other institutions who are developing geriatric centers, and an important site of patient-oriented research in geriatrics. When a patient brings a loved one to our center for an assessment, he or she will receive: A comprehensive history and medical exam Risk evaluation for falls, mobility, and musculoskeletal complaints of back or joint pain Comprehensive cognitive exam and depression screening A review of medications and an evaluation for polypharmacy A review of patient priorities and goals of care Caregiver counseling An assessment for home-based care needs, as well as for nursing home and assisted living placement