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.

Advances in basic and clinical research in genetics are changing the understanding and practice of neurology. In Neurogenetics, we evaluate and diagnose adult and pediatric patients with complex neurological disorders in which a genetic connection potentially exists. Our team provides long-term management of patients with a wide range of inherited disorders of the nervous system, including neurodegenerative and neuromuscular disorders, familial epilepsy, genetic forms of stroke, familial neuroimmunological disorders, neurodevelopmental disorders of children, and autism spectrum disorders. We also counsel family members of our patients to help them understand these conditions and care for their loved ones.

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