The Geriatric CARE Center (GCC) was established in 1984 to coordinate geriatric activities between the medical school and its two teaching affiliates, University Hospitals and the Cleveland VA Medical Center. Dr. Kowal, Director of the GCC, is also the Amasa B. Ford, MD Professor of Geriatric Medicine, Associate Dean for Geriatric Medicine, and Director of the Office of Geriatric Medicine at the CWRU School of Medicine. The GCC also includes the Western Reserve Geriatric Education Center (WRGEC), a consortium of three medical schools, several teaching hospitals and four professional schools funded by the Bureau of Health Professions, which provides support for the development of faculty and other trainees in the health care professions specializing in geriatrics and gerontology throughout northern Ohio.

The GCC has grown to fourteen full time core faculty and forty closely affiliated clinical and research faculty. Clinical activities include multidisciplinary Ambulatory Assessment Units at University Hospitals and the VA Medical Center (March 1985), a 15 bed geriatric evaluation unit at the VA Medical Center, an experimental geriatric inpatient acute care unit at University Hospitals, and multidisciplinary consultation services at both hospitals. The faculty of the Division of Geriatric Medicine also provides consultation on the inpatient geriatric psychiatry service and to all the acute medical and surgical service patients at University Hospitals of Cleveland. Additional training activities occur at community-based long term care sites.

The extensive clinical, educational and research activities in geriatrics and gerontology have established Case Western Reserve University (CWRU) as a leader in the field of aging. The CWRU Claude D. Pepper Older Americans Independence Center was awarded in December 1992. Over 60 CWRU faculty have research projects in aging funded in excess of $9,000,000 annually.

Major areas of biomedical and clinical research involvement in aging at CWRU include neurobiology, behavioral neurology, musculoskeletal disorders, endocrine/metabolism, pulmonary physiology, infectious disease, epidemiology and health care delivery research. GCC and Pepper OAIC initiatives have stimulated increased participation of established laboratories and have resulted in the development of new networks among clinical and basic scientists.

We have expanded our research options as a result of our NIA Claude D. Pepper Older Americans Independence Center and have new community oriented clinical and educational initiatives outside of the traditional academic setting. Interest in geriatrics has resulted in joint ventures with other subspecialties, including Infectious Diseases, Cardiology, Gynecology and Pulmonary Medicine. Additional relationships have been established for joint training of fellows with the other clinical geriatric programs in the area, including Family Medicine and General Internal Medicine.

Fellowship Training

The Division of Geriatric Medicine of the Department of Medicine at University Hospitals of Cleveland is the teaching arm of the GCC. The Division offers a variety of clinical and research training fellowship experiences. These fellowships are jointly supported by a variety of sources including the National Institute on Aging (NIA), University Hospitals of Cleveland, the Cleveland VA Medical Center and the CWRU School of Medicine's Office of Geriatric Medicine.

Through competitive federal granting initiatives and excellent institutional support, our program has been recognized as a leader in training in aging research and geriatric medicine. The principal focus of the Geriatric Medicine fellowship program is to prepare physician scientists and geriatric clinicians for faculty positions in aging at academic institutions and hospitals. This is accomplished through a coordinated program of direct involvement in clinical geriatric medicine, research training and the development of teaching skills. Our fellowship program was accredited in 1988 and reaccredited in 1994 by the Residency Review Committee for Internal Medicine of the Council for Graduate Medical Education.

Sites of Clinical Activity

University Hospitals: Geriatric ambulatory clinical care activities at UHC are shared with those of the Alzheimer Center at a free standing facility--the University Foley ElderHealth Center (EHC). The EHC provides a range of diagnostic activities, counseling and referral services. It is a principal site for medical student and Internal Medicine and Family Medicine residency training in geriatrics. The EHC currently averages 50-60 new assessments per month and has a total of over 5,000 patient visits per year. The EHC is recognized nationally a unique clinical site where various medical disciplines practice in an integrated manner for the benefit of patient care. The EHC is located in the Fairhill Center for Aging, a campus devoted to providing services for older populations.

In 1990, as a result of a Hartford Foundation Award, an inpatient geriatric unit, the Acute Care for the Elderly (ACE) Unit was developed. This study is currently supported by the National Institute of Aging CWRU Claude D. Pepper Older Americans Independence Center. The ACE Unit is a 15 bed service designed to be the core of a randomized study of factors which may prolong hospital stay, decrease quality of life, and lead to prolonged insitutionalization. The "Prehab" program of generalizable medical, nursing, and social interventions is designed to shorten hospitalization and promote independent living.

Cleveland VA Medical Center: The VA geriatric program includes a 15 bed inpatient Geriatric Evaluation and Management (GEM) Unit, an ambulatory assessment clinic, inpatient and ambulatory Geriatric consultation and inpatient screening of all hopsitalized veterans over 70 years of age. Affiliated activities at the CVAMC include a 190 bed skilled nursing facility and Hospital Based Home Care.

Community Long Term Care Sites include Home Care and the Judson Retirement Community, a non-profit organization which provides independent and assisted living, skilled nursing and stepdown care.

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