A new center for geriatric, palliative care opens

Like all organizations that serve older adults, the Palo Alto Medical Foundation is preparing for a coming tsunami of Baby Boomers entering old age.

The foundation last month opened the doors to its new Guzik Family Center for Geriatrics and Palliative Care — a specialized corner of the Palo Alto clinic that will offer older patients preventive care, extra-long appointments, larger-than-usual exam and consultation rooms to accommodate family members and, when necessary, home visits and palliative care.

“We want to be the epicenter of what’s right in aging,” said Peter Cheng, a gerontologist who for the past nine years has been using borrowed exam rooms in the internal medicine department to see patients.

“We feel like the traditional medical experiences that older people face are generally suboptimal. Folks are rushed through a primary care experience, and there’s not always a meaningful acknowledgement of partners — families and community-based services — that are vital to seniors.

“We want to offer that extra layer of support and explore new frontiers for successful aging.”

Donors contributed $3 million to furnish the new center on El Camino Real, a former storage area in the basement that’s adjacent to parking and a short walk to the laboratory, the pharmacy and the departments of radiology and oncology. The major donor was Nahum Guzik, a Soviet-born technologist who arrived in California by way of Israel in 1973. Guzik said he was grateful to PAMF for the care his family — particularly his mother — and his employees had received there.

“This project was funded entirely by philanthropy — entirely,” surgeon and PAMF Executive Vice-President Tony Marzoni told a group of donors and doctors who gathered for a celebration a few days before the Guzik Center’s June 15 opening. The new center, Marzoni said, “is making the case for a service that doesn’t begin to cover its costs but is the right thing to do.”

Between 2010 and 2030, the proportion of Santa Clara County residents 60 or older will nearly double, going from 15.7 percent to 27.6 percent of the population, according to the county’s Department of Aging and Adult Services. The fastest-growing segment of that population will be “the oldest of the old (those 85 or over),” the department’s 2014 annual report stated.

More than 90 percent of older adults have at least one chronic illness, and the U.S. Centers for Disease Control estimates that seven out of 10 Americans die from chronic disease. An estimated 77 percent of seniors experience more than one chronic condition.

“These trends have increased the need for PAMF to innovate in the delivery of geriatric and palliative care programs,” said Kathryn Engle, a communications and philanthropy officer with Sutter Health, of which PAMF is a part.

Cheng said his older adult patients run the gamut from the 91-year-old who drives himself over from Half Moon Bay in his convertible to people who need the help of family members to get to their appointments.

“We don’t make assumptions,” he said.

The Guzik Center will back up a patient’s existing primary care doctor, taking more time, for example, to delve into preventive measures with patients and assess risk for common age-related conditions like memory loss, falls and depression, he said. Many of the risk assessments are done through the department’s “Mind, Body and Soul” program, in which groups of eight patients meet in a three-part workshop to discuss strategies for successful aging.

“We’re a medical subspecialty — just like cardiology, gastroenterology or orthopedics — set out to design programs to support people all along the aging journey,” Cheng said. “We keep the primary care doctors very involved and let them know what’s happening with their patients. It’s not realistic for us to be primary care for everybody — this country in my lifetime will never have enough geriatricians and palliative care doctors to serve as primary care doctors.”

Several primary care physicians attending the pre-opening event said they referred their patients to geriatrics because of the team’s ability to spend more time on issues specific to the aging process.

For patients with serious illness, the palliative care team offers extra support focused on pain and stress relief without necessarily giving up on curative treatment, said Sharon Tapper, medical director of PAMF’s palliative care programs offered in Palo Alto, Santa Cruz, Mountain View, Sunnyvale, Fremont and Dublin. It is not to be confused with hospice care, which traditionally provides treatment focused on a patient’s comfort rather than on curing a disease.

Palliative care, provided by a team of doctors, nurses and other specialists, is “appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment,” Tapper said.

Local resident Mary Horngren said Cheng’s care late in the lives of her parents, Joan Horngren and Stanford University accounting professor Charles Horngren, caused her to become a supporter of the Guzik Center.

When the Horngrens first met Cheng in 2007, she said, “Peter shook everyone’s hand, sat down with us, and talked to my parents, in his usual soft-spoken manner, as if he had all of the time in the world.”

Over the next four years, as each parent died, “Peter was with us every step of the way,” Horngren said. “My mother had Alzheimer’s disease; my dad had kidney disease late in life. Dr. Cheng walked us through the journey to their deaths with such grace and compassion and expertise.

“We had many family conversations with Peter over several years about planning for a ‘good’ death without extraordinary measures. Peter mirrored my folks’ pragmatic Midwestern values about facing reality and preparing for what’s inevitable for us all,” Horngren said.

In geriatrics and palliative care, Cheng said, “We want people to realize that they have a lot of power to make sure that medicine is able to honor their wishes for the right types of care when they’re at their sickest and most vulnerable moment.

“We want to make sure people are feeling comfortable that they can do this proactively — identify their priorities before the system runs wild doing what the medical people feel is the obvious thing but is very often counter to what an older person’s wishes are.”

Asked whether this meant limiting extraordinary measures to extend the life of a terminally ill patient, Cheng responded: “I don’t use the word ‘limit.’ But above all I think we need to inform, and we want to teach and inspire.”

Contributing Writer Chris Kenrick can be emailed at ckenrick@paweekly.com.