When Joachim Silbermann first met Mark S. Lachs, M.D., more than 12 years ago, he began with a joke that has become a familiar ritual between them. "If only you knew something about old people," he would tease. That caused Dr. Lachs to chuckle a bit the first few times. He is the Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine and co-chief of Weill Cornell's Division of Geriatrics and Gerontology, along with Ronald Adelman, M.D., professor of clinical medicine. Both are internationally renowned geriatricians.
But Mr. Silbermann was getting at something deeper: that growing old is complex and challenging in ways that are both medical and non-medical, and that older people are profoundly diverse despite many negative stereotypes that are just plain wrong. Sure, there are 75-year-olds who have been rendered frail by health problems, but there are many more who are fully engaged in lifelong careers and hobbies, and others who are just starting new ones. While we may acquire new diagnoses and conditions as we get older, they need not lead to disability.
Joachim and Rosanne Silbermann (center) with Dean Antonio M. Gotto Jr. and Anita Gotto.
"As Joe met our geriatricians, he told me he was impressed not only by their technical skills, but also their very humanistic qualities," said Dr. Lachs. "In a typically prescient fashion, he looked at the larger world and he saw what we saw: older people who should be among the most cherished members of society being overlooked, understudied and undertreated."
Over the years their relationship has taken many forms: doctor-patient, mentor-mentee, and ultimately, close friends. As that friendship grew, Mr. Silbermann expressed an increasing desire to help the Division of Geriatrics and Gerontology at Weill Cornell Medical College to develop innovative ways to enhance care for older people in the areas central to the Weill Cornell mission — superior patient care, research and teaching the next generation of doctors. Together they talked through creative programs not only to train more geriatricians ("There will never be enough of us given the aging tsunami," says Dr. Lachs), but to make sure that physicians in training — whatever their specialty — master the basic art and science of caring for older patients. "He was absolutely instrumental in helping to develop our Division from the very start," Dr. Lachs said. "I might start a conversation wanting to know about him, but invariably he moves every discussion to focus on the Division's latest accomplishments, struggles and aspirations."
The Silbermann Family has funded three Clinical Scholar Awards to support junior-level faculty, each with a distinct imprint, as well as the $1 million Joachim Silbermann Family Discovery Grant in Age-Related Ophthalmic Research. The grant is a shared initiative between the Division of Geriatrics and Gerontology and Weill Cornell's Department of Ophthalmology under the leadership of Donald J. D'Amico, M.D., professor of and chairman of the Department of Ophthalmology. "My wife, Rosanne, and I have been fortunate to receive the very best care at Weill Cornell," Mr. Silbermann said. "I want others to have access to the same kind of excellence. It is essential for a society that is experiencing unprecedented increases in longevity."
The first Silbermann Family Clinical Scholar recipient was Veronica M. LoFaso, M.D., a nurse and a physician by training, who founded the Division's House Calls Program — "the antidote to high-tech medicine," says Dr. Lachs. "Our faculty members go out to visit older patients in their homes, black bag and medical students in tow. Many students spend extra time with us on electives or in the summer making many house calls because they describe it as a transforming experience."
Dr. LoFaso says House Calls keep patients' illnesses from worsening, help to prevent loneliness and depression, and often eliminate the need for visits to the emergency room. The House Calls Program partners with New York City social services agencies who care for older people to make sure those who need medical help find their way to the program; those agencies also integrate other important services like Meals on Wheels to comprehensively integrate medical and non-medical services. "Dr. LoFaso has won a bevy of humanism and teaching awards as a result of her compelling impact on students. She is an amazing doctor and teacher and the program is absolutely rooted in hands-on care," Dr. Lachs added. Every single Weill Cornell medical student now makes a house call before graduating.
Dr. Mark Lachs
Taryn Lee, M.D., the recipient of the second Silbermann Family Clinical Scholar Award, established a geriatric consultation service at NewYork-Presbyterian Hospital, which provides advice to non-geriatricians caring for older people on other services in the Hospital. The consulting geriatric physician can be called in for any number of reasons, such as situations when an elderly patient becomes confused, if a physician is concerned about whether discharge is safe, or if drug combinations are appropriate. "Every consultation is an opportunity not only to bring excellent care to patients, but also a 'teachable moment' to influence an aspiring surgeon or other specialist to be a bit more gero-friendly," Dr. Lee says. "Over the course of a career, consulting geriatric physicians will care for thousands of older people, so the ability to make an impact is huge, both in direct care and imparting knowledge to other doctors." Mr. Silbermann's vision and support was leverage — Dr. Lee recently received a prestigious geriatric academic career award from the United States Bureau of Health Professions for her work in geriatric consultation, and now leads a national interest group in geriatric medicine consultation for the American Geriatrics Society.
Alleviating pain in older people is the focus of the third Silbermann Family Clinical Scholar Award. "Pain diminishes quality of life," Mr. Silbermann said. The gift enabled the Medical College to recruit Cary Reid Jr., M.D., Ph.D., a nationally renowned expert in pain in older people. Working with faculty from Cornell University in Ithaca, Dr. Reid is studying non-drug alternatives to pain management. He is also taking his research and doctoring directly out to neighborhood senior centers throughout Manhattan. He spends a good deal of his time listening to people who live with chronic pain, and thinking about new solutions.
In the Hospital, Dr. Reid is part of a palliative care service that includes a multidisciplinary team of physicians, nurse practitioners and social workers. Patients with poorly controlled symptoms not just limited to pain (such as shortness of breath, anxiety and depression) in the course of illness are also expertly cared for. The team also focuses heavily on the needs of family members, who are invariably affected by a loved one's illness.
"There will always be a need for a caring physician to relieve pain and suffering, even if medicine cannot 'cure.' I see this as a fundamental role of the doctor," Dr. Reid has said. "I look forward to providing that service to patients, teaching those important skills to our students, and to researching the ways in which these services can be more effectively brought to patients."
Antonio M. Gotto Jr., M.D., D.Phil., the Stephen and Suzanne Weiss Dean, said the Silbermann family's giving supports "one of the most important aspects of medicine dating back to Hippocrates, namely, the relief of suffering. Providing these services to patients from all walks of life has also been a consistent theme in the Silbermanns' generosity," said Dean Gotto, who appointed Mr. Silbermann as a lifetime member of the Dean's Council. "We are grateful for the vision, the kindness and the altruism of the Silbermann family."