Student Life
Geriatrics
Research
Philip Lee, a third-year medical student at JABSOM, recently published research in Nature Aging (2024 Impact Factor of 19.4) calling for a new model of care for geriatric fractures, an issue specifically pertinent to Hawaiʻi, which is among the fastest-aging states in the United States.
“The U.S. healthcare system is too fragmented,” Lee explained. “Fractures are one of the leading causes of morbidity in geriatric patients. An elderly patient might have a fall, end up in the operating room for a hip fracture, and never follow-up with rehabilitation and their primary care doctor. That barrier has shown to significantly worsen functionality and long-term health outcomes.”
Instead, Lee and his collaborators propose a multidisciplinary approach, where geriatricians work alongside orthopedic surgeons, physical therapists, and other specialists from the very start. Their recommendations are guided by the “5 Ms” framework of geriatrics: Mind, Mobility, Medications, Multicomplexity, and “What Matters Most.”
What Matters Most is especially important, Lee says. “We don’t always need to think about 20 years down the line. For an 80-year-old, their priority may be having the ability to play with their grandkids. What matters most to them should guide our care.”
The call to rethink fracture care comes at a critical moment. By 2050, the population of adults over 65 is projected to triple, with those over 85 increasing 5-fold. In Hawaiʻi, by 2035, when the last baby boomer reaches retirement age, nearly 1 in 3 Hawaii residents will be over the age of 60, according to Civil Beat. Fragility fractures, such as hip fractures caused by osteoporosis, already account for a significant burden on the healthcare system.
Lee’s research shows in the U.S., one in two women over 50 will experience an osteoporosis-related fracture in their lifetime. This issue is even more pronounced in Hawaii because Japanese Americans, one of the largest ethnic groups in the state, experience higher rates of osteoporosis. “Hawaiʻi is a melting pot with many Asian communities,” Lee said. “This research is particularly relevant here and challenges my colleagues and I to address the future needs of our community.”
Lee notes that Hawaiʻi’s healthcare system could be well-positioned to lead in this area. With HMSA and Kaiser Permanente dominating the market, there are fewer insurance providers to coordinate with compared to the mainland. “That means it might actually be easier to create smoother transitions in care here, from the operating room to rehabilitation to long-term prevention,” he said.
However, workforce challenges loom. “We need more geriatricians, more primary care doctors trained in the nuances of aging, and maybe even fellowship-trained orthopedic surgeons who specialize in geriatric care,” Lee said.
For Lee, publishing in a high-impact journal like Nature Aging is not just a personal milestone, it’s a chance to shine a light on how Hawaiʻi may help combat the rapidly aging future. “I hope this research catalyzes similar projects at home,” he said. “We can continue building national recognition for our clinical excellence and academic strength.”