Clin-STAR Journey Story

Research and Patient Care in the Era of COVID-19: A Geriatrician's Perspective

Until last winter, geriatrician Thomas K.M. Cudjoe, MD, MPH, cared for most of his patients by visiting them in their homes. But by early March, with the spread of COVID-19 and the need to limit physical contact with patients, Dr. Cudjoe and his colleagues at the Johns Hopkins Home Based Medicine (JHOME) program began transitioning to telemedicine.

Then, in his role as a Major in the Army Reserve Medical Corps, Dr. Cudjoe was drawn even deeper into the response to the COVID-19 pandemic. He had joined the US Army after high school, attended college with a Reserve Officer Training Corps (ROTC) scholarship, and was supported by the military as he earned his BS at Hampton University and MD at Robert Wood Johnson Medical School. He then completed residency at Howard University Hospital and a fellowship in Geriatric Medicine and Gerontology at Johns Hopkins, where today he is an assistant professor.

In early April Dr. Cudjoe was deployed with the US Army Reserve, as a member of an 85-person team of medical professionals called the Urban Augmentation Medical Task Force 332-1, first to a New Jersey field medical station, and then to University Hospital in Newark. For seven weeks, he supported the local staff in transitioning recovering COVID-19 patients out of the hospital. Experience as a geriatrician prepared him well for this unprecedented emergency.

"Compared to many other specialties, geriatricians provide care across the health system," he says. "We are in every care setting extending from hospital to home. We care for older adults in emergency rooms, inpatient medical wards, as consultants, and co-managers pre- and post-operative. We provide outpatient consults, memory care, and complex primary care. We work in assisted living facilities, nursing homes, skilled nursing facilities and even provide care for older adults who need to be seen in their homes.”

"For the situation in Newark I understood the needs to be met as someone goes home, or to a facility. My geriatric expertise enabled me to care for patients, and also to help contribute to the thinking about how a clinical group should approach care transitions."

While busy at University Hospital, Dr. Cudjoe observed how the crisis was affecting vital social connections for older adults—the focus of his research. He led a study published in 2018 that found that—in "normal" times—one in four older adults is socially isolated. Other research shows that more than 40 percent experience loneliness. The health consequences are becoming more widely acknowledged, among them, increased risk of illness, dementia and death. A recent National Academy of Sciences report spotlighted these issues.

The pandemic has exacerbated social isolation among older adults, with stay-at-home orders and physical distancing, which means among other things that senior centers are closed, nursing homes are banning visitors and grandparents are often limiting contact with their grandchildren. In response, and following on earlier research, Dr. Cudjoe and Ashwin A. Kotwal, MD, MS, at the University of California, San Francisco, co-authored a letter in the Journal of the American Geriatrics Society, describing how the current constraints provide a unique opportunity to envision, pilot and implement novel solutions that could have a lasting impact beyond the pandemic, on the health and well-being of older adults.

Back in Baltimore, Dr. Cudjoe reflected on how COVID-19 will impact research going forward. He is a recent recipient of an NIA Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) award studying social connections and health among older adults living in low-income housing.

"Most of that research, when I envisioned it, was to be done in person," he says. "There are things that you garner from that direct interaction—you glean things about their environment, about how they interact with you, and how they respond to questions."

But in the wake of the pandemic, "we have to evaluate the risks and benefits of in-person interactions.”

"Another area for research is quality improvement—how do you optimally meet the needs of individuals whom you can't directly interact with in person, either in their home or in clinical settings of the hospital or ambulatory practice?"

For Dr. Cudjoe, the urgency to address these issues goes beyond healthcare. "My interest in aging and the importance of social connection comes out of my experience caring for my grandparents and the valuable role that I think older adults play in our society," he says. "The connection and engagement of older adults in the lives of others is critically important. It impacts their health, but also impacts the next generation."