Health

30 HEALTH • Winter 2016 D r. Gerry Gleich didn't initially set out to treat the elderly, but as his career progressed and his patients got older, he found himself drawn to car- ing for the aging population. Today, Gleich, a Long Beach, N.Y. native, is the medical director of Fallon Health's NaviCare program, which provides transportation, care management and other support ser- vices to MassHealth-eligible people over the age of 65. In addition to Fallon, Dr. Gleich is a clinical associate pro- fessor in the department of Family Medicine and Community Health at the University of Massachusetts Medical School, a faculty family physician at Hahnemann Family Health Center, and medical director of St. Mary Health Care Center. He is a graduate of UMass Medical School in Worcester, and also completed a residency in family medicine at UMass. Q: Have you always been interested in geriatric care? A: That was an evolution actually. I'm a family medi- cine physician, and for many many years I did full- spectrum family medicine -- I delivered babies, I took care of women for prenatal care, I took care of babies on through the entire spectrum up to older people. And really over the last 15 to 20 years, I've become more interested in geriatrics. I've always been a teach- er at UMass [Medical School], and geriatrics became an interest and the population I cared for became older, as I progressed in my practice. As people age, their goals for what their life is going to be like for whatever time they have left changes. And medicine is something that we oftentimes do by protocol. For some medical conditions that works very well, but with older people you really have to individ- ualize. I find that conversation and learning about what really matters to a person to be something that drives me. Q: What are some of the behavioral health issues that are specific to the elderly population? A: There are common themes about aging that play into the behavioral health issues that older people have. Depression exists throughout the spectrum of age. Sometimes in older people depression exhibits itself a little bit differently. People who are older are pretty good at adjusting, that's how they get to be older. They're survivors. They've learned how to deal with whatever life throws at them. So sometimes even though they may have restricted a lot of activities in life because they're just not feeling the energy or maybe feeling depressed, they might not say that they're feeling sad. They say 'I'll be okay.' Loss is a common theme of aging for many people. If you think about it, you're getting older, your friends are getting older too, and getting medical problems. Some of them die, so you lose some of your social world. Especially if you lose your spouse or a close partner. That can be a pretty devastating thing. Also, people who have retired, who now have lost the sense of pur- pose of (what you do every day.) And then sometimes the downsizing that occurs of having to live in a place where you're not in charge of things anymore. Q: Can you talk about the project you are work- ing on with the Alzheimer's Association? A: Dementia is a growing problem nationally, as the population ages. We'll see more and more people with dementia in the community. And probably 50 percent of people who have dementia haven't been properly diagnosed. Part of what we're doing with our regular team is to make sure we're recognizing dementia by screening for it, but we're starting a project with the Alzheimer's Association where we are making a refer- ral of everybody that we see who has dementia to the Alzheimer's Association. And they are going to implore a memory specialist who is an Alzheimer's Association employee who then does a comprehensive assessment of that person, their caregivers, their fami- ly and that whole system to identify a whole checklist of things that really should be done for that person because everybody has different needs. So they'll do this assessment, create a list of tasks to accomplish and share it with our team, and then two months later do a follow-up on each of our members. Q: What's the difference between Alzheimer's' and dementia? A: Alzheimer's is a type of dementia. But dementia is a more general term. It means a problem with the ability to think. Alzheimer's is more or less a chronic, degen- erative disease of nerve cells in the brain. Not every- thing is understood about Alzheimer's – like what causes it. We know things about brain cells that are affected by the Alzheimer's, but the initial thing that causes it to happen is really still unknown. We really think that in trying to prevent Alzheimer's or vascular dementia, or other dementias, the best way is to focus on good cardiovascular health. All the things you do to keep your heart healthy also keep your brain healthy. Don't smoke, exercise, control high blood pressure, control cholesterol -- all of those things are really very helpful. This interview was conducted and edited for length and clarity by Laura Finaldi. P H O T O / L A U R A F I N A L D I Dr. Gerry Gleich { Profile } Director of Fallon Health's NaviCare program H

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