#b#To the Editor: Rethink Geriatrics#/b#

Here’s the problem. Seniors in New Jersey can expect to see more doctors and undergo more tests during their final years of life than in any other state. Our state ranks highest in the nation in healthcare dollars spent on Medicare beneficiaries, in the amount of time spent in the hospital, and in the intensity of physician services delivered in the hospital.

What’s wrong with that, you ask? True, this high level of service sounds beneficial, but it has a negative impact on the quality of life and comfort of many of New Jersey’s older citizens. According to the Dartmouth Atlas, health outcomes for New Jerseyans are no better, and perhaps worse, when compared to other states. Our aggressive use of hospital services has not brought better health outcomes and greater satisfaction with healthcare.

The problem is that the goals of elder patients are not routinely taken into consideration — or even elicited — until it’s too late. The present model for healthcare in New Jersey is for physicians to pursue curative therapies until the patient approaches an actively dying phase. Only then does the physician discuss the goals of care with patient and families.

Patients, however, might not want to spend their final months or weeks in a hospital setting, receiving aggressive medical interventions. Instead of longevity, they might choose, for their remaining time, greater quality of life and comfort.

They might want simply to be able to live long enough to attend a family event such as a wedding or graduation. Or to enjoy their garden. Or to dance with a spouse. Once these activities are impossible, they might choose to forego aggressive medical therapies.

Decision-making in geriatric medicine should start well before the actively dying phase. To address this, last year I initiated a not-for-profit organization called New Jersey Goals of Care to spearhead the effort to improve medical decision-making on behalf of older patients. The organization aims to improve healthcare delivery by aligning a patient’s specific goals of care with available therapies to achieve the best possible outcome for that patient.

New Jersey Goals of Care functions as a partnership program that unites private and public organizations interested in improving geriatric clinical decision-making in New Jersey. It is taking a leadership role in directing efforts in government, academic, neighborhood, and medical communities to initiate strategies for improved communication between patient, physician, and healthcare teams.

Goals of Care aims to open the pathway between doctor and patient on several fronts: educating and empowering the public, training young doctors, adding to medical school curriculum, and working with hospitals and nursing homes.

An exciting pilot project is planned for the University Medical Center at Princeton and nine nearby skilled nursing homes.

It is time we empower the older patient in New Jersey, and I invite you to hear more about New Jersey Goals of Care on Sunday, April 3, at 2 p.m., at Erdman Hall, Princeton Theological Seminary, 20 Library Place in Princeton. I will be speaking and answering questions at the annual meeting of the Funeral Consumers Alliance of Princeton. The talk is free and open to the public.

David R. Barile MD

David R. Barile, a board-certified doctor in internal medicine, geriatric medicine, hospice, and palliative medicine, oversees the Acute Care of the Elderly unit at the University Medical Center at Princeton. He is executive director of New Jersey Goals of Care.

#b#Win Some, Lose Some: First the Bad News …#/b#

AS A LONG TIME YARDLEY resident (and Princeton real estate taxes refugee), I was delighted to see the March 23 article, but some fact-checking would go a long way towards the credibility of the author and the publication.

Sadly, U.S. 1 playing fast and loose with minor (and not so minor) details takes away quite a bit from the story that you are trying to tell – and I am only addressing the facts that jump right at you and do not require in-depth knowledge.

1. There were never any rail tracks in place of the canal.

2. No flood ever reached Main Street, forget “washing over it.”

3.The towpath never transforms into any avenues for its entire length.

4. The Yardleys did not “stay on for the next 150 years,” they are still in town (we bought our house from Ann Yardley, and her son Ralph still lives here and is listed in the phone book, how is that for sophisticated research?). In my math, that’s a whole lot closer to 300 years.

5. Cold Spring beverage is just a distributor, but not a maker of beer, and they never owned the property so they could not technically sell it. The proposed development, a really divisive issue for the residents, is not going to bring “untold number” of families — the highest number debated was about 60 town homes, which no doubt would end up being less than that. “The rumored price,” as a matter of fact, was high 700-low 800 hundreds.

6. The neighboring town that borrows Yardley name is Morrisville, not Morristown.

7. The antique show takes place at the community center, not senior center since we do not have one.

8. Yardley’s “high end real estate” does not top out at about a million. The two most expensive homes in the borough proper sold at $1,250,000 and $1,415,000 respectively at the height of recession; and the listings that you mention in the article only confirm that (however, one of the listings seems to be withdrawn and one under contract).

There might be a whole lot more along the same lines, I believe, that would be visible to Yardley residents who are better informed than I and better conversed in the life and history of the community.

Marina Scudder

136 North Main Street, Yardley

#b#. . . And Some Good#/b#

I AM WRITING TO THANK you for the wonderful article published about my client, Penny Bussell Stansfield, and me, “Birthing Books and Babies,” in the March 16 issue of U.S. 1.

How often do we hear people lament on the fact that they lost their job due to corporate downsizing, were sidestepped for a promotion, or were replaced by someone younger, and then wallow in self-doubt not knowing what to do next or where they should focus their efforts? Despite having huge Roladexes, they can’t seem to open doors as easily as they could when they were employed. While these emotions are real, and we all experience them to some degree, I think it’s important to take the time to turn that search inward and discover or uncover one’s hidden strengths and talents that lie just below the surface.

In my case, I knew innately that I wanted to do something totally different from what I had done in the past. I was in search of a new challenge that would provide me with a deeper sense of personal satisfaction and would allow me to help others achieve their dreams. After successfully helping companies build their businesses, shed obsolete product lines, or restructure and take on a new fresh identity, I knew that it was time to use these talents and rebuild my own identity. It was my time now to leverage all the skills I had honed over the past 20 years and create something that could flourish and grow.

After securing a commitment from my former colleagues, illustrator/editor Bruce Arant and art director Jill Abrahamsen, to join my team, I knew that we had a solid foundation to build something powerful. We each have strengths in different areas, but yet share common values and goals that have made our collaboration a strong one from the start.

The response to the article in U.S. 1 has been enormous, and the outpouring of letters, phone calls, and requests for meetings is confirmation that my team and I are on the right path. Your interest in carrying our story is very much appreciated. Thank you for giving us the chance to shine.

Marie Galastro

President, MLG & Associates

Congratulations to Michele Alperin for her patience in wading through her voluminous notes to craft an article that not only reflects my personality, but also captures the essence of what I am trying to do: inspire and motivate people as they go through the process of career transitions and/or reinventing themselves in mid-life.

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