History of Mount Sinai’s Geriatric Medicine

Established in 1982 as the first academic geriatrics department in the United States, Mount Sinai’s pioneering tradition of geriatric medicine can be traced to the beginning of the 20th century. In 1909, Ignatz Leo Nascher, MD, former Chief of Clinic in the Mount Sinai Outpatient Department, and a pioneer for this sub-specialty, coined the term “geriatrics” in his first paper on geriatric medicine.

Ahead of his time, Dr. Nascher suggested this new term as “an addition to our vocabulary, to cover the same field in old age that is covered by the term pediatrics in childhood, to emphasize the necessity of considering senility and its diseases apart from maturity and to assign it a separate place in medicine.” Dr. Nascher’s foresight was that much more impressive considering that at the time he was practicing medicine, only 4 percent of the U.S. population was over the age of 65, and the average life expectancy was 45 years.

Five years and more than 30 articles later, Dr. Nascher, in 1914, wrote the first American textbook on geriatric medicine, Geriatrics: The Diseases of Old Age and Their Treatment, Including Physiological Old Age, Home and Institutional Care, and Medico-Legal Relation. Another Mount Sinai giant, Abraham Jacobi, MD, one of the founders of pediatrics in the United States, wrote the introduction to this landmark text.

A champion of geriatrics throughout his professional life, Dr. Nascher wrote more than 50 articles on various subjects relating to geriatrics and founded the New York Geriatrics Society. He accomplished all of this despite the indifference and, often, the outright censure of both the medical establishment and the public. Dr. Nascher remained hopeful that geriatrics would soon become one of the major specialties of medicine taught and practiced. It was a somewhat premature hope, however, for in the years following Dr. Nascher’s retirement in 1929, geriatrics all but seemed to disappear.

In 1921, Frederic D. Zeman, MD, a Mount Sinai physician, concentrated his efforts on developing a patient-centered model of care for the aged at the Home for Aged and Infirm Hebrews, later known as the Jewish Home and Hospital for Aged and now, the Jewish Home and Hospital. Dr. Zeman served there as medical director for 45 years. Then, in 1962, he formed the first experience-based instructional facility for training in geriatrics in the United States. Shortly after his death in 1970, the training center was renamed the Frederic D. Zeman Center for Instruction.

“Medicare and Medicaid were created in 1965, as well as the passage of the Older Americans Act. However, none of the federal appropriations for these programs was earmarked for the training of geriatricians. A significant advance toward such training occurred in 1972 when Mount Sinai physician Leslie Libow, MD, initiated the first nationally recognized geriatric fellowship (later residency) in the U.S., approved by the American Board of Internal Medicine and located at the City Hospital Center at Elmhurst, Queens, a major teaching affiliate of the Icahn School of Medicine. After the success of this fellowship at Mount Sinai and at Elmhurst, other institutions followed suit.

Around the same time, the first academic nursing home in America was also established at Elmhurst, linking residency and fellowship training, medical and nursing student training, and research. Years later, this model of the academic nursing home was termed the “teaching nursing home.”

It wasn’t until 1979, when Fred Sherman, MD, was recruited to the Department of Medicine that Mount Sinai had its own Division of Geriatrics. Another milestone for the Division was the formation, in 1980, of an interdisciplinary Geriatric Consult Team made up of a physician, a nurse, and a social worker. Using a team-based approach, they created programs that addressed the medical and psychosocial needs particular to aging.

Mount Sinai was quickly emerging as a leader in geriatric medicine, which reached a peak in 1982 when Mount Sinai became the first medical school in the United States to establish a freestanding Department of Geriatrics.

With the creation of the Department came Mount Sinai’s own geriatric fellowship program, which remains one of the largest such programs in the country. The program’s components include education, research, and clinical care for a range of geriatric patients, from healthy to acutely ill or frail elderly patients.

By July 1983, the Coffey Geriatrics Outpatient Clinic had opened its doors, enabling physicians to see ambulatory patients. Around the same time, the inpatient Geriatric Evaluation and Treatment Center – later renamed the Mobile Acute Care for the Elderly (this acronym isn’t needed since it isn’t mentioned again within the document.) Unit – was established. Both programs utilize a team-based multidisciplinary approach and focus on helping patients to regain and/or maintain the highest level of independence possible.

The year 1985 marked the 50th anniversary of the passage of the Social Security Act, the 20th anniversary of the creation of Medicare and Medicaid, and the 10th anniversary of the National Institute on Aging. In the same year, Mount Sinai graduated its first geriatrics fellows, and in collaboration with the Department of Psychiatry and the Bronx Veterans Administration Medical Center, the institution established one of the first Alzheimer’s disease research centers in the country.

In 1987, stimulated by the Mount Sinai program, the first nationally recognized formal guidelines for geriatric fellowship training programs were published. In 1990, the Department of Geriatrics at Mount Sinai inaugurated the U.S. branch of the Internal Leadership Center on Longevity, which still exists today.

In 1995, the Department was ushered into a new era, with a reinvigorated emphasis on research and policy change that included the newly formed Laboratory for Neurobiology of Aging and the establishment of the Center for Evidence-Based Medicine and Aging.

That same year, the groundwork was laid for the establishment of a Palliative Care Clinical Consultation Service, which opened its doors in 1998. Since then, the Department has remained at the forefront of academic palliative care, actively promoting hospital-based palliative care, clinical research, and education through the Center to Advance Palliative Care and the National Palliative Care Research Center.

In 2007, Mount Sinai opened the Martha Stewart Center for Living, a new model for the practice of geriatric medicine, helping to change the way we think about and experience aging. It houses the Coffey Geriatrics Associates primary care practice that specializes in caring for older adults, bringing together under one roof a centralized source of patient care, referrals to other physicians, programs for caregivers and the community, and a full range of complementary and integrative therapies as an adjunct to traditional medical interventions.

In June 2010, Mount Sinai broke ground on a new inpatient Palliative Care Unit in which we will begin caring for chronically ill patients in 2011.

Mount Sinai’s Department of Geriatrics and Palliative Medicine has come a long way since its inception in 1982. Governed by a holistic sense of health and well-being, our department leadership believes that medicine has an obligation to care for both the individual and the community in all aspects of health. Our mission is nothing less than changing the way we look at, think about, and experience aging on a global scale.