When doing less may do more for aging patients

When Dr. Diane Wintz talks with people about the medical topic she’s most passionate about, she asks them to imagine the following scenario: A 95-year-old woman with advanced dementia lives at home. Though she has caregivers, she is still able to navigate her daily routine, including moving around the house with a walker, and is living comfortably. But a minor medical issue arises that would normally be treated in a hospital.

“While the great doctors, nurses and health care providers can treat that medical issue, going to the hospital removes the woman from her comfortable routine,” Dr. Wintz points out. “There are unfamiliar faces, strange noises, her sleep schedule is thrown off. So treating this minor medical issue may actually speed up the patient’s mental decline and increase what we would call delirium. In turn, that could decrease the chances this patient could ever be able to return to living at home.”

The need to personalize treatment

In this example, the patient has reached what Dr. Wintz calls a “medical inflection” point — a point where less medical intervention may actually be better for the patient’s overall wellbeing.

As the medical director of the trauma department at Sharp Memorial Hospital, Dr. Wintz is used to making quick decisions to save the life of the patient in front of her. But she’s also seen enough real-life versions of the hypothetical situation she described to start making her think differently about the needs of older patients.

“We’re only going to know how their needs are different if we can get to the know the patient — what matters most in their care — so we can help make decisions to get them the outcomes they want,” she says. “That’s different than just treating the illness.”

A new model for care

In 2019, Dr. Wintz helped launch a pilot program at Sharp Memorial to put her ideas about personalized care into action. The almost-immediate success of the program has led to the development of the John M. Sachs Family Center for Generational Health.

When a person age 65 or older arrives for treatment — whether it’s for a trauma, such as a fall, cancer treatment, a heart attack or anything else that requires hospitalization — they’ll see team members from Generational Health in addition to the doctors treating the injury or illness.

Depending on the patient’s needs, this may include nurses, occupational therapists, physical therapists, speech pathologists, respiratory specialists, chaplains and even art therapy and pet therapy program specialists. They’ll all work together to keep the patient’s desires for their care at the forefront of the treatment and ensure that the care is delivered in a way that is designed to keep them as active as possible, both physically and mentally.

“Sometimes it’s simple things, such as moving tests to different times to protect sleep, encouraging them to get out of bed and go for walks, handing them a crossword to keep them engaged, or even bringing in a therapy dog for a visit.” says Dr. Wintz.

Other times, she continues, it’s having significant conversations about what treatment to do or whether to even do treatment at all. “Sometimes, a patient may be happier going back home without treatment than dealing with the ramifications of treatment, even if they may live longer,” Dr. Wintz says. “We’ll only know if we’re actively working with them and their family to find out what matters most to them.”

An approach that works

Results have shown that this approach is shortening the length of hospital stays, reducing instances of delirium, and increasing the number of patients released and able to return home. In fact, more than 50% of patients who go through the Generational Health Program discharge directly home, more than twice the rate of unenrolled patients.

“Instead of looking at each case from the perspective of what medical interventions we can provide, we look at it from the perspective of what this patient needs to thrive,” says Dr. Wintz. “It’s a person-centered approach.”

Encouraged by the positive outcomes experienced by patients since the pilot program began, the Generational Health concept is expanding. It will be introduced at Sharp Coronado Hospital, Sharp Grossmont Hospital and Sharp Chula Vista Medical Center by early 2026.

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