Dear Researchers:

Here’s My Question...
Help!  Can you find a list of doctors who are the leading experts in
the treatment of Alzheimer’s disease and/or elder care that practice
in the South Bay area of Los Angeles (or nearby areas, keeping in mind
“elderly”)?

The Background
I am the primary caregiver for my 91-year-old mother who has a Dx of
probable Alzheimer’s disease.  For some time now, I’ve been of the
belief that much of her suffering is preventable.  Regardless, she’s a
real trooper and for her age and illnesses is doing pretty good
considering she’s missing one very important thing.  In the five years
that I’ve cared for her, we have gone from doctor to doctor, health
plan to health plan searching for a primary care physician—with or
without a subspecialty in Geriatrics—who actually has the special
knowledge about the elderly (and Alzheimer’s) that the moniker
Geriatric Medicine promises.  Her current doctor and the best of her
past doctors wanted to treat her the same way they treat their 35
year-old patients. Worse, they lack current knowledge of how to treat
the “oldest old” and thus continually were unknowingly placing her in
situations of potential harm (some of actual harm).  Each time I
search for a new doctor for her, I do a dozen or so interviews with
doctors and their staff so it’s not an exaggeration to say that we’ve
done our do-diligence.  Sadly, many of the docs I interviewed, as well
as some of her past doctors clearly went into Geriatric Medicine for
marketing reasons and hadn’t kept up or were never up to begin with. 
What’s truly shocking is that so much of this information is only a
click-away on the Internet.  There’s little excuse for their lack of
knowledge, except business [read money-greed].  I don’t mean to sound
angry; I’m really just frustrated.  Is this how we’ve been treating
elderly folks all these years?  She is currently on original medicate
with MediGap insurance and can afford to pay for part of her care
along with what the family can do.  Like many of us, she’s not fond of
the doctor’s office and baulks a little at going but when she does,
she’s responsive and anxious to cooperate, participate and get it over
with.  And although I’m prejudice, I think she’d be a great patient
for a doctor who actually practiced geriatric medicine, if we could
only find one.  We’ve been lucky over the last five years and I’ve put
in some extra effort to keep things going, but her health care is an
accident waiting to happen.  Is what we’re looking for so unreasonable
(that’s not a research question)?

Clarification #1
I’m a freelance writer turned family caregiver who regularly conducted
research on the Internet in the process of completing an assignment. 
So I naturally conducted my own investigation into my question. 
Having said that, I will admit to actually being a better writer than
researcher (don’t tell anyone).  You see, I spent some time reading
answers provided by Google Answers (researchers) and have to say I’m
impressed and a little hopeful.  I tell you this to let you know that
I’ve been the Healthgrades, Findoc, etc. route and most of these site
simply collect information from other websites, such as specialty
boards, to tell a very limited and rather generic amount of
information on a doctor.  I’m hoping I’ve missed some little-known
sources of information that you folks know about.  Show me how a real
researcher can come up with the answers, please.

Clarification #2
In my question, I ask for doctors in our area that are “recognized as
the leading experts in the treatment of Alzheimer’s disease and/or
dementia.”  I phrased it that way because we’ve had so little luck in
finding a primary doc with the knowledge to handle being her primary
doc.  However, in reality, any doctor with the experience and current
knowledge of the elderly and their special issues with a modicum of
good bedside manor would be just fine.  My thinking on the best
strategy for managing her health care is to take her to one physician
who acts as her primary care provider.  This doctor focuses on the
whole person including the Alzheimer’s and other coexisting conditions
and refers her to and is the main communicator with specialists as
needed.  I view this doctor as a sort of doc-of-all-trades who in
covering all the bases knows how far to go before making a referral. 
Please feel free to tell me if this is an outdated model or just not
the best way to go today.  I’m open to learning what works.  I also
see this doc as being proactive—heading off preventable disease before
it hits, which goes to quality of life issues.  I know Medicare’s
emphasis is on treatment of existing conditions and pays little for
prevention, but a dedicated and creative doctor could get around that
(legally).  Bottom line, he or she can be a specialist, a generalist,
an authority, a local doc with no great credentials or whatever so
long as they know how to treat the oldest old.

The “Good Answers” Example
Here’s a little more information to give you a real world sense of the
type of doctor for which Iseek.  In fact, the existence of this
example has been the one thing that’s kept me searching in spite of
not finding.  I read a lot of medical pubs on the web in an effort to
not only be a good medical consumer and patient advocate but to better
understand things from the docs POV.  One of these publications is
GERIATRICS (www.geri.com) published by Advanstar Healthcare
Communications.  Fredrick T. Sherman, MD is its Medical Editor and
writes a regular column in each issue.  Dr. Sherman is without a doubt
the type of doctor appropriate for someone in mom’s condition, but he
practices in New York—a bit too far for us to drive even for a good
doctor.  Nonetheless, he’s a great example of a doctor who is
knowledgeable and active in his declared practice areas and someone
who also really cares about doing his best for his patients.  His
experience, knowledge and genuine concern for his patients and his
trade virtually leap from his articles, as do his sense of humor,
bedside technique and willingness to be creative in finding patient
solutions.  This comes through is his writing so very well.  If I
could only clone him and convince his clone to move to the west coast.
 You can visit his articles all in one place and get a feeling for
what I mean at http://www.geri.com/geriatrics/author/authorDetail.jsp?id=155

---

Request for Question Clarification by umiat-ga on 19 Oct 2003 22:35 PDT

Hello, frankwriter-ga
 In order for a researcher to search efficiently for a good doctor, it
is important to know the doctors (or facilities) that you have ruled
out. It sounds as though you have done a few dozen interviews with
doctors with no satisfaction. Therefore, in order that a researcher
does not go over the same territory, can you tell us the ground you
have covered already?
 Also....have you tried calling Dr. Fredrick T. Sherman personally for
recommendations of like-minded doctors in the Los Angeles area?

umiat

Hello, frankwriter-ga!

 
 The description you have provided concerning the time you have spent
caring for your mother and your desire to find the "right" doctor who
can discern your mother's special needs while appreciating her
continued zest for life is very heartfelt. You undoubtedly love your
mother and have been extremely devoted in caring for her.

 You have asked for "a list of doctors who are the leading experts in
the treatment of Alzheimer’s disease and/or elder care that practice
in the South Bay area of Los Angeles (or nearby areas, keeping in mind
"elderly")?

 While it would be wonderful to find that one magic doctor who has all
the qualities you seek rolled up into one, your mother's needs might
be best served through a comprehensive care clinic. Fortunately, you
have one of the very best facilities in your own backyard!

 UCLA Medical Center was ranked the #1 Geriatrics Hospital in the
nation in the 2002 rankings by US News and World Report:
http://www.usnews.com/usnews/nycu/health/hosptl/rankings/specihqgeri.htm

 I don't think you could ask for anything more ideal than the
interdisciplinary approach to geriatric services offered at the UCLA
Medical Center. As noted, UCLA Medical Center has consistently ranked
as the best hospital in the western United States. The Geronet program
has two clinics which are extremely comprehensive and should provide
most everything you need for your mother. The Geriatric clinic even
helps with homebound care, should you ever feel the need for some
extra help caring for your mother at home.


====================================
UCLA MEDICAL CENTER GERONET PROGRAM
====================================
http://www.geronet.ucla.edu


UCLA Multi-Campus Program in Geriatric Medicine and Gerontology
Geriatric Clinic
===============================================================================
200 UCLA Medical Plaza, Suite 420\
Los Angeles 90095 
(310) 206-8272 (Patients Information and Appointments) 
Clinical Care for Older Adults at UCLA: 
200 Medical Plaza
Suite 420 
Information and appointments: (310) 206-8272 
http://www.geronet.ucla.edu/healthcare/clinical_care.html

"UCLA's specially trained physicians and other health care
professionals offer a wide range of geriatrics services using a
multidisciplinary team approach. They provide comprehensive and
continuing health care services designed to keep older adults healthy,
active, and independent. Medical staff diagnose and treat the common
problems often associated with growing older, including high blood
pressure, heart disease, arthritis, osteoporosis, diabetes,
depression, incontinence, memory loss, difficulty with walking, and
other age-related conditions."


On-site services include: 
--------------------------
* Ongoing primary medical care. 
* Consultation and evaluation of age-related problems. Referrals can
be made by physicians, social workers, families or patients.
 * All new patients and those seeking consultations receive a
Comprehensive Geriatric  assessment by a multidisciplinary geriatrics
team to evaluate the individual's physical and emotional health,
memory, skills and ability to maintain independence in managing
everyday tasks.
* Women's clinic: Consultation for menopause, osteoporosis, urinary
incontinence, and gynecological problems of older women.
* Referrals to other UCLA specialists as needed 
* Hospitalization, if necessary, at UCLA Medical Center, ranked best
hospital in the Western United States for ten years.


Off-site and post-hospitalization services: 
--------------------------------------------
* Transitional post-hospital and nursing home care services. 
* Long-term care services at several Los Angeles facilities. 
* Rehabilitation and physical therapy. 
* Community-based geriatric services. 


The multidisciplinary team includes:
-------------------------------------- 
* Board Certified Geriatricians - primary care physicians specializing
in caring for older persons.
* Geriatric psychiatrists - experts in treating the emotional problems
of older persons.
* Geriatric nurse practitioner - supplements physicians in the ongoing
management of health problems and medications.
* Social Worker - helping to keep older persons independent and in
their homes.
 

Additional specialists as needed include:
---------------------------------------- 
* Podiatrist 
* Dermatologist 
* Neuropsychologist 
* Physical therapist
* Other specialists at UCLA Medical Center
 

Social services available include: 
-----------------------------------
* Ongoing care management services. 
* Information and referral services. 
* In-home services for the homebound. 
* Assistance in evaluating and locating living arrangements, including
assisted living and board-and-care homes.
* Individual, family and group counseling. 
* Caregiver support groups. 
* Assistance with the Department of Social Services, the Social
Security Administration and other government and private agencies.

Insurance:
---------- 
* UCLA Medical Center accepts Medicare assignment and most
supplemental insurance.


===


UCLA Alzheimer's Disease Center 
===============================
http://www.geronet.med.ucla.edu/centers/alzheimers/index.htm
 
"The UCLA Alzheimer's Disease Center (ADC) is an interdisciplinary
collaborative enterprise dedicated to improving the lives of
Alzheimer's disease (AD) patients and their caregivers through
clinical care, research, and education. The UCLA ADC embraces the
ultimate goal of preventing AD and the proximate goal of discovering
the best means of optimizing the cognition, function, and behavior of
the patient and the quality of life of the patient and the caregiver.
The UCLA ADC provides comprehensive clinical assessments and
longitudinal care; offers services and referrals to caregivers; trains
future neuroscientists dedicated to AD research; and provides
education programs to clinicians that will optimize the care of AD
patients and their caregivers. The UCLA ADC fosters research that will
increase understanding of the basic mechanisms and potential therapies
of AD, improve diagnosis and treatment of AD, and enhance the
dispersion of knowledge regarding care of AD patients to professionals
and caregivers. The UCLA ADC accepts the challenge of developing
clinical, research, and educational programs appropriate to a
multiethnic and multicultural society."


*********


 Two more suggestions follow. While I cannot vouch for either one, I
would imagine that the Keck School of Medicine at USC would also be a
very reputable facility. Dr. Loren Lipson is the Chief of the Division
of Geriatric Medicine, and I have seen him highlighted in various
articles concerning geriatric issues.

For example:

"USC Experts Assist Alaska's Elderly Veterans". (February 2, 2003)
http://www.usc.edu/dept/gero/nrcshhm/library/news_archive/
 
Dr. Jon Pynoos, Professor of Gerontology and Policy Services at the
USC Leonard Davis School of Gerontology along with Loren G. Lipson,
Chief of the Division of Geriatric Medicine at the USC Keck School of
Medicine, are assisting the Veteran's Administration (VA) with advice
to reconsider a plan to create a new facility that would have
centralized services for elderly Alaskan veterans in a single
location.




============================================================
KECK SCHOOL OF MEDICINE AT UNIVERSITY OF SOUTHERN CALIFORNIA	
============================================================
http://www.usc.edu/schools/medicine/departments/medicine/clinical/clinical_practice/index.html

Geriatric Medicine Division
---------------------------
http://www.usc.edu/schools/medicine/departments/medicine/clinical/clinical_practice/geriatrics.html

"The physicians of USC Geriatric Medicine specialize in care of the
older adult. Geriatricians focus on all aspects of care and the
special needs of seniors at the USC Center fort Senior Health Care.
USC geriatricians conduct research on prevention, diagnosis and
treatment of conditions affecting seniors."

USC Center for Senior Health Care:
"Patients at the USC Center for Senior Health Care benefit from the
wide range of specialty services at USC, including neurology,
psychiatry, pharmacology and nutrition, head and neck surgery,
orthopedic surgery, urology, occupational and physical therapy,
gerontology, pharmacy and dentistry. The Center provides comprehensive
consultation as well as inpatient and outpatient care including:

The multidisciplinary consultative geriatric assessment of medical,
psychological and functional status

Senior wellness programs, including risk factor reduction, cognitive
stimulation, nutrition, exercise and increasing overall functioning

Retirement planning programs, including wellness and fitness,
retirement counseling and evaluation of functional status

Pharmaceutical therapy, consisting of consolidation of medications and
adjustment of doses for the senior patient

Evaluation and treatment planning for special senior health issues,
such as memory loss, falls, incontinence, dizziness, diabetes,
hypertension, poor nutrition and sexual dysfunction


(Read more about the Geriatric Programs at USC:
http://www.usc.edu/schools/medicine/departments/medicine/divisions/geriatrics/clinical/



****************



The Geriatric program at Century City Hospital is worth investigating
although I know nothing about the Hospital's reputation.

 
Century City Hospital 
=====================
2080 Century Park East, Suite 400,
Los Angeles 90067 
(310) 201-6789  Fax: (310) 201-6112 
http://www.centurycityhospital.com/CWSContent/centurycityhospital


Geriatric Services
-------------------
http://www.centurycityhospital.com/CWSContent/centurycityhospital/ourServices/medicalServices/Geriatric+Services+.htm

"Located in a special unit on our medical campus, the Center for
Geriatric Health is dedicated to preserving the health and
independence of older people and provides an array of services.

The Geriatric Day Hospital is a comprehensive outpatient program of
geriatric assessment that utilizes a team of geriatric specialists.

The Geriatric Psychiatric Unit provides inpatient care devoted to the
specialized needs of the older patient.

Century City Hospital Reflections provides fundamental inpatient
psychiatric treatment in an outpatient setting.

Caregiver issues are addressed through monthly support groups and
quarterly free seminars on geriatric-related issues.

The Center for Geriatric Health offers geriatric assessments
specializing in the evaluation of:

Memory 
Balance and Falls
Depression 
Pressure sores
Anxiety
Multiple Medications
Urinary Incontinence
Aging
Agitation 
Behavior problems 


The Center for Geriatric Health also offers:

Comprehensive rehabilitative services
Geriatric consultations
Community and family education
Support groups
Home Health
Local transportation


====================
 

 I hope these suggestions are helpful. As I stated, I think you (and
your mom) are blessed with a great treasure by having the UCLA
Gerontology Program right in your own backyard.

I wish you and your mom the very best! And thank you for showing her
such tremendous love and care! You are a rare blessing.

umiat

Google Search Strategy
geriatric specialists AND los angeles
gerontology specialists AND los angeles
geriatric experts AND los angeles
best hospitals for alzheimer's
Century City Hospital

Hey umiat,

Thank you for your thorough, levelheaded answer.  Believe it or not, I
know of UCLA Medical Center’s Geriatric program and the US News and
World Report article from my own research.  UCLA came up in a search
for interdisciplinary programs after I snagged an article on the
progress and efficacy of such programs as I looked for “what’s new” in
elder care.  This was a year ago while searching for her current
doctor.

So, you’re thinking, what happened?  Why didn’t we end up at UCLA?  A
number of influences pushed us in a different direction; with emotions
and perceived comfort dominating over practical realities.   As an
early baby boomer, I’m probably the last generation to experience
physicians as they were, oh say, pre-HMO’s, for lack of a better
label.  I’ve long since made the transition to the high-tech
HMO-dogged doc of today; but I remember what it was like.  Mom, on the
other hand, may have made the effort to transition (although I doubt
successfully), but because of Alzheimer’s she has no memory of it—her
recollection of the doctor experience lives in the 1940s and 50s.   As
such, today’s healthcare realities are pretty jarring to her;
especially since she is also missing memory of the medical progress
that softens some of the bumps in today’s healthcare road.  So a year
ago, when doctor decision time came, she warmed to the standalone doc
vs. the institution.  While I legally have the final say, we both do a
lot better when I engage her in the process and I was somewhat
ambivalent at the time.   And that’s how we ended up there and doing
that.

You are, however, right—-we are fortunate to have one of the very best
facilities in our own backyard!  And this time around she’s facing
more ills, not feeling as well and did enough suffering under the
current doc to go with my recommendation.

My decision to let her go with the individual practitioner over the
noted institution might appear to some as a mistake and it might have
been.  However, in the time warp of Alzheimer’s disease, we don’t
operate that way—something I sense you may understand.  For the
benefit of your readers, I will briefly explain (sorry can’t help
myself).  With this disease, any landing is a good landing.  There’s
simply not enough time or energy to assign blame or feel guilt for
missteps in dementia care—the monster disease all too quickly consumes
it and uses it to drag you down.  There’s only doing your best,
staying healthy, remembering the person in care is first your
loved-one and second someone with an illness, and finally never become
so busy with life that you miss the occasional often simple golden
moments when things stabilize enough to connect and enjoy the one that
this is all about.

All this is a roundabout way of telling you that your comments and
research are right on target.  And although I do not know you
personally, your work provides insight into your humanity and
professionalism.  Not just research; your answer included perspective
personalized to my need.  I respect and appreciate that.  As an
x-freelancer, I know there is a certain degree of risk in giving
personal perspective with your work.  On the face of it, your answer
to my question was not what I expected but was clearly what I needed.

Thanks again.  You get an A+.

Sincerely...frankwriter