Lipschitz Has Big Dreams for The Longevity Center at St. Vincent
David Lipschitz, M.D., Ph.D. examines Don S. Floyd of Bryant at The Longevity Center at St. Vincent. "Dr. David" hopes lessons learned in his 30 years at UAMS will help the new center become an international leader in longevity and wellness for seniors.
Dr. David dreams big.
That's part of the appeal of David Lipschitz, MD, PhD, the acclaimed geriatrician and longevity expert known nationally and internationally as "Dr. David." In July, Dr. David left the University of Arkansas for Medical Sciences (UAMS) where for 30 years he had built its renowned geriatrics program and founded the Donald W. Reynolds Institute on Aging, to create at age 65 a bold new senior health initiative at St. Vincent Health System in Little Rock.
The goal for The Longevity Center at St. Vincent, Lipschitz said, is to prepare the baby boomer generation and their parents to live out their days healthily, independently and with as much happiness, dignity and respect as possible.
A new paradigm of healthcare and wellness promotion is needed to address the "graying of America," he said, and is needed urgently.
"After spending 30 years at UAMS looking at the future, it's patently apparent to me that the aging of the baby boomers is going to become probably the single biggest domestic crisis facing America's future," Lipschitz said. "Unless we alter the way we practice and plan for healthcare, I think our entire system will almost certainly be overwhelmed."
He said that in the next 20 years the number of 85-year-olds in America will double, and in the next 30, it will triple.
"About 8,000 people are turning 60 everyday and 7,000 are turning 50," Lipschitz said. "Now, 50 percent of the 85-plus population is dependent, either because of declines in memory or because of physical disability. They're the major utilizers of our healthcare system. If that many are dependent and the number is doubled, the resources to meet this population's needs, let alone those between the ages of 50 and 85, will be grossly inadequate. It will be harder to get into an assisted living center than it is to get into Harvard."
The best way to prepare for that eventuality is to begin at once helping the over-50 population learn to live their final decades independently and free of disease, he said.
Lipschitz said, "The big question is, can we do that in our current healthcare system, which primarily focuses on high technology for acute care, prolonging life at all costs but paying little attention to prevention or attention to early detection and treatment of disease? We have to change that. I believe that we need to do this in a community-based hospital, because that is the site where most bread-and-butter medicine is practiced. University hospitals primarily focus on high-technology tertiary or quaternary care and pay little attention to the day-to-day needs of the population.
"That's the reason I moved to St. Vincent. This is an ideal location to develop a program that might revolutionize the way we practice healthcare."
St. Vincent CEO Peter Banko said he had only been at the hospital for a week or two before two board members independently told him that the single best thing he could do in his tenure there would be to bring Lipschitz aboard.
"He and I had an opportunity to meet informally last summer and started talking about healthcare…what organizations particularly hospitals need to do to change themselves for the future," Banko said. "The more he talked, the more his vision became clear, and it was fairly congruent with where I thought St. Vincent and healthcare needed to go in general. I think he's looking to do something different in his career and something revolutionary. I bought into that vision."
St. Vincent has made a "several million dollar" commitment to The Longevity Center, Banko said, with plans to expand that over time. The center has integrated with St. Vincent's existing geriatric services, with geriatricians David Liu, Jennifer Co and Bushra Shah supporting Lipschitz' work on the St. Vincent Infirmary campus in Little Rock and St. Vincent North in Sherwood.
The health system plans an aggressive expansion of the program, Banko said. Although in its nascent stages it is currently serving only Central Arkansas patients, within the next few months the center will begin a statewide education and awareness effort, and within a year begin attracting out-of-state patients.
Lipschitz said his patients fall into three categories: those who are dependent because of memory decline, those who are dependent because of physical debilitation and illness, and those who are "remarkably healthy."
Whichever category a patient is in, The Longevity Center will provide an efficient, one-day, multidisciplinary evaluation and plan with the patient and their partner or family members.
People with memory loss that results in dependence see a physician, then have their memory tested by a neuropsychologist, and have the needed x-rays and laboratory tests. The day ends with a team meeting in which the physician, a patient educator, the neuropsychologist and a social worker will meet with the patient and the family to discuss the diagnosis and a treatment plan. Lipschitz said education about all aspects of memory loss follow and the family is made aware of resources available in the community to help cope with memory loss and how to receive support and advice should a problem arise. Most importantly, Lipschitz said, the patient will have access to highly trained healthcare providers and support groups to promote the patient's and family's quality of life as the disease progresses.
For patients with physical debilitation, the one-day evaluation by physicians, nutrition, exercise and physical therapists, social workers and educators results in a comprehensive plan to improve their well-being and reduce their level of dependence. "We know that careful and meticulous management of medical problems can substantively improve quality of life," Lipschitz said. "Furthermore, physical therapy and appropriate exercise can dramatically improve strength, gait and balance, reduce the risk of life threatening falls and often make it possible for the patient to live alone and be able to engage fully in life. Management of other medical problems such as pain, shortness of breath, dizziness and many other symptoms can do much to improve well-being."
Lipschitz said the most novel aspect of the new center is the program for the healthiest people, which centers around 10 steps that he has identified over the years and intensely studied to reach an older age and be totally independent (see related sidebar for 10 Longevity Steps). Because compliance with the steps is enhanced when participants reinforce each other, The Longevity Center is encouraging participants to come in pairs: married couples, partners, friends, etc. The one-day evaluation each receives for readily detectable illness also includes meetings with a nutritionist and an exercise physiologist and an evaluation of how prone they are to success. The team develops, with the participants, a plan to deal with the Lipschitz'10 steps and their implementation, including (for local people) a 12-week course that covers all the topics.
Continued contact through e-mail, Web sites and mailings provides ongoing and lifelong support to keep participants empowered, involved and on a path toward a better, happier and more independent life, Lipschitz said. From health promotion and disease prevention, to acute care, to care in assisted living and nursing homes and end of life care, he said The Longevity Center would be involved in every aspect of the continuum of care for baby boomers.
Dr. David Lipschitz' 10 Steps to Longevity
For 30 years, David Lipschitz, MD, PhD, has studied the science and medicine of longevity. While traditional medicine seeks
to cure disease, his emphasis is on promoting wellness. Especially benefi cial to people who are not physically or mentally
dependent already, he says, are these 10 not-necessarily-medical steps he has identifi ed and researched as key promoters
of health and longevity.
1. Be passionate about everything you do—Love what you do. If you don't, you'd better change. It doesn't matter
your age. If you're not enthusiastic or passionate about what you're doing, then your life will not be as good and your risk of
disease will go up.
2. Be peaceful — Stress is a major predictor of poor health and a shorter life expectancy.
3. Have more love in your life — Men who are in long-standing monogamous, intimate and loving relationships live
10 years longer than a single man does. Women live longer, too, but not as much. It's not only the love that exists between a
couple, but also the love that exists between a parent and child, a doctor and a patient, a teacher and a student, or the love
that exists in many communities. Love is very important.
4. Understand the importance of self-love — Individuals who have poor self-esteem are much more likely to become
ill, to have heart disease, cancer and dependence. People who think they're fabulous live longer.
5. Have more laughter and/or more sex — If sex is out, better laugh a lot. If sex is in, laugh and have hanky-panky.
Both are associated with a longer life expectancy. People who have a great sense of humor and laugh a great deal appear to
have about eight years longer life than those who do not.
6. Embrace your faith, whatever it may be — The way in which faith links to a longer and better life is through being
spiritual. You don't have to be a person of strong faith to be good, honest and ethical, loving, giving and forgiving.
7. Develop a better relationship with food — Everybody wants to get into shape, to diet. Diets fail and we have to
develop a new approach to dealing with food. We have to stop eating for comfort and start eating for health. We have to stop
focusing on weight and start focusing on eating the right kinds of foods for the right reasons.
8. Move more — Aerobic stretching, balance exercises and weight training are especially good for living a long, independent
9. Be an empowered and educated consumer of healthcare — Don't believe everything your doctor tells you and
learn to navigate the healthcare system yourself.
10. Understand you are free to do anything you wish — Once you reach the age of 50 and beyond, you are free.
You're free to eventually think about retiring, free to move or age in place, free to change careers, free to do anything. Imagine
System, Heal Thyself
Simultaneously, St. Vincent is following Lipschitz' lead toward curing their health system of a problem he and Banko agree is endemic to healthcare in general.
"We're going to make St. Vincent known as a truly geriatric-friendly institution where people will be guaranteed rational, affordable and accessible healthcare,
Lipschitz said, explaining, "By 'rational,' I mean that everything we do will be done on the basis of sound scientific evidence benefits. Much of the healthcare in the U.S. is inappropriate, unnecessary, excessive and much too expensive. There are so many things that we do that have been proven to be of little value." As examples, he cited extra tests, ineffective procedures, interventions that are of no proven benefit, using the most expensive rather than the cheapest medication, admitting to the hospital unnecessarily.
Banko said that while St. Vincent has a "strong following" from the over-50 population, all U.S. hospitals need to be doing more to address their specific needs.
"I don't think any hospital around the country that I'm aware of is really doing a great job caring for that 50 plus population," Banko opined. "That's where most of our workforce is, where a large percentage of our inpatients come from. There are opportunities to provide care in different ways using evidence-based practice that will benefit the patients and the healthcare system as a whole."
"The answer is not with politicians," Lipschitz said. "They know nothing about healthcare. The answer lies with doctors. The doctors are the ones who order the tests, who manage healthcare, who make the decisions. We are the ones that are largely responsible for excessive or inappropriate care because of the role of the physician as a noble profession is being changed to a bottom-line profession. That has to change if we are to meet the demands the future will place on us."
Plenty of current literature identifies best practices that work every time they are employed, Banko said, yet hospitals do not make it a priority to do those every time.
"For instance, we know that when you come to the hospital for pneumonia, getting you antibiotics within a certain period of time improves outcomes, yet not 100 percent of the time do hospitals do that," Banko said. "I think Dr. David brings that focus and energy to help us leap out into the forefront. It's the number one thing I talk about and it's the number one thing Dr. David talks about, and now it's becoming the number one thing every employee and physician is talking about."
Many of the physicians at St. Vincent he said are on board with the plan, while others are more cautious. "It's a new concept and Dr. David's new to St. Vincent. There are always folks who are early adopters and others that have come on board and others that are waiting and watching. That's a normal part of any organizational dynamic," Banko said.
He said that on a Sunday after the recent premiere of St. Vincent's new emergency room, a surgeon who had been talking with Lipschitz called Banko at home.
"He said, 'You know, when you're around him, you get it. His passion and energy are infectious. I came home that night fired up about being a surgeon, being a doctor,'" Banko related.
Banko said he understands that dynamic. "I like being around Dr. David. He's a bold thinker. It helps my thinking as a CEO and leader. He pushes the boundaries; neither everything he thinks of nor everything I think of becomes reality, but at least it gets you thinking about doing things differently."
Brainstorming the Future
Arkansas is uniquely positioned to be a leader in geriatrics, thanks to the leadership of the Donald W. Reynolds Institute on Aging, The Longevity Center, and the encouraging number of geriatric Centers of Excellence throughout the state, Lipschitz said.
"What we have is a network of programs that are uniquely tailored to meeting the needs of an older population. We rank really high in the nation in terms of the number of geriatricians that practice here. Only in Arkansas is there a geriatric program within a 50-mile radius of where you live. That is an incredible accomplishment," he said. "If you look at Northwest Arkansas, for instance, there is a center on aging in Fort Smith, there is a wonderful program in Springdale—the Lawrence Schmeiding Senior Health and Education Center—and there is also an outstanding geriatric program at Washington Regional. So that area of the country is blanketed with high-quality geriatric practitioners, which really is a unique resource for the state. There is so much we can do here."
One evolution of The Longevity Center Banko and Lipschitz have been kicking around, and about which Lipschitz is increasingly passionate, goes something like this: The Longevity Center at St. Vincent develops a strong national and international reputation as a visionary paradigm of how to care for the growing numbers of people entering the prime of their lives. A new facility is built in Little Rock, strategically centered at the heart of a new mixed-use community that will allow baby boomers and their parents to "age in place" comfortably and conveniently. The Longevity Center would have a nearby hotel for out-of-town patients and close-knit housing options for older people who never want to move again, healthcare services and assisted living facilities, all surrounded by profuse education, shopping, entertainment and dining options with integrated public transportation to all. That overall community, expressly planned with the needs of the geriatric population in mind, could become a model for similar communities across the nation.
That's big stuff, but Lipschitz said it's possible.
"We're just getting off the ground now, but I've done it before," he said. "At UAMS, we started in a tiny little room in a tiny little building and now we have probably the single best geriatric program in the nation. I just want to take what I've learned there and do something even better."