Dr. Susan Mitchell is a senior scientist at Hebrew SeniorLife whose pioneering research focuses on decision-making, health outcomes and resource utilization for older people near the end of life, particularly those with dementia. I recently had the opportunity to speak with Dr. Mitchell about the motivation and vision behind her work.
Of the many medical specialties available, why did you become a geriatrician?
Dr. Mitchell: I didn’t want a specialty that focuses on one organ system; I wanted to address the whole person. I think seniors tend to have interesting medical conditions, and I genuinely like older patients.
Once I started working in geriatrics, I gravitated toward end-of-life issues because I saw that even though many patients are quite frail in their later years, they often get very aggressive treatment that is contrary to their wishes and preferences.
You’ve done a lot of research involving palliative care. What is it, and why is it important?
Palliative care focuses on maximizing symptom control and quality of life in patients who often (but not always) have a terminal illness. Palliative care can be combined with treatments that focus on curing the condition, which is different from a hospice model, where the patient has decided not to pursue curative treatments and to receive comfort care instead.
Palliative care is a movement that’s gained momentum over the past 10 to 15 years, so it's still a relatively new concept. Unfortunately, not many patients or families are aware of it — I think it's an option that more physicians can and should bring to the table when discussing end-of-life care with patients and their families.
I'd like to see a real change in how we approach caring for seniors in their last months and days. Currently, the default is to do the most aggressive thing, when we should be delivering care that aligns with the patient's and/or family's preferences. In many cases, that's palliative care.
You seem to have enormous compassion not just for ailing seniors, but also for their families. How did that come about?
Dr. Mitchell: It’s almost like pediatrics — these patients can’t advocate for themselves, so their family members have to do it, and I want to support them in doing so. When you're looking at end-of-life care planning, you have to encompass the patient's family; that has to be ingrained in the culture of the nursing home, too. It’s about educating families and helping them access their choices.
What would you like to see changed in how care is provided to seniors at the end of their lives?
Dr. Mitchell: It would be great to implement quality initiatives that reward nursing homes for providing high- quality palliative care.
You’ve done so much groundbreaking work. What are you most proud of?
Dr. Mitchell: I'd have to say the CASCADE study, which for the first time characterized end-stage dementia as a terminal illness. Most people think of dementia as a disease that affects the brain, not something that people die from.
There is a lot of attention focused on prevention and early detection of dementia, but we can’t ignore the millions of people who live to the end stage of this disease. Dementia is such a long disease, and we need to find ways to make that experience easier for both patients and their families.