The designation recognizes emergency departments with specialized expertise, staffing and resources for patients 65 and older, who represent about one-third of all patients treated in Cedars-Sinai’s Emergency Department each year.

“This recognition reflects our commitment to delivering exceptional, patient-centered emergency care for the older adults of our community,” said Claude Stang, RN, executive director of the Cedars-Sinai Emergency Department. “As the No. 1 Medicare provider in California, we care for thousands of older adults every year, and we are dedicated to keeping them safe and healthy.”

Accreditation reviewers cited several programs and features that distinguish Cedars-Sinai’s approach to geriatric emergency care, including the Barry and Rena Plost Senior Emergency Center within the Emergency Department.

“We try to place patients who would benefit from a quieter environment in our senior care unit, where private rooms, dim lighting and reduced noise can help minimize delirium for patients who are susceptible,” Stang said. “Those seemingly small changes can make a meaningful difference for older adults in the Emergency Department.”

Other components highlighted by reviewers included:

• A specialized geriatric nurse assessment team, trained to identify delirium, dementia, fall risk and social determinants of health.
• Integrated physical therapy and pharmacy services, including prescription medication screening, review and reconciliation.
• Senior-friendly amenities, including reserved reclining chairs in the waiting area, improved signage and lighting, handrails, and accessible bathrooms.
• Tender Loving Care volunteers, who are specially trained to provide companionship and comfort for older adult patients.
• A physician who leads ongoing education on geriatric emergency care for physicians and physician assistants.

Level 1 accreditation builds on Cedars-Sinai’s broader commitment to age-friendly care. The health system also has been named an Age-Friendly Health System Committed to Care Excellence, a recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

“Older adults often have unique medical and social needs that require a different approach to emergency care, that centers around the 4M’s (What Matters Most, Mobility, Medications and Mentation) of age-friendly care,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai. “As an Age-Friendly Health System, every member of our team plays an important role in ensuring patients receive compassionate, specialized attention from the moment they arrive through a seamless transition to the next stage of their recovery.”

The Emergency Department’s research team also has been active in advancing geriatrics research, publishing on sepsis, brain injury, cardiac biomarkers and observation care. The work helps to inform evidence-based practices that further strengthen care for older adults.

Emergency Department Expansion Underway

The accreditation comes as Cedars-Sinai continues a major expansion of its Emergency Department, an investment designed to increase capacity while supporting the specialized care needs of a growing patient population.

The project will add 16,550 square feet to the department and increase the number of care spaces from 60 to 100.

Sam Torbati, MD, chair and medical director of the Emergency Department, said the project is expected to be completed by the end of 2028.

“Smaller improvements, such as a new laboratory, are expected to open this fall,” Torbati said. “Patients will begin to see more significant changes next summer.”

The first major phase will add 15 acute care beds, eight behavioral health beds to treat patients with mental health needs, six critical care and trauma beds, and a dedicated room designed to care for critically ill children. The expansion also will include new waiting areas, an updated triage space and a redesigned patient entrance to improve capacity and the overall care experience.

“Demand for emergency care continues to grow, and we’re committed to finding new ways to improve the experience and quality of care for our patients,” Torbati said. “The expansion is a significant investment in meeting those needs.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Elam, 91, has been retired for 23 years from her job at United Food and Commercial Workers Local 770. And she is thriving, says Elam’s physician, Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai, because Elam is doing retirement the right way.

“Carrie’s doing many of the things we encourage our patients to do as they age— keeping herself physically healthy and having a full social calendar,” Rosen said.

Statistics from the U.S. Bureau of Labor Statistics show nearly 20% of today’s workforce are 65 or older, up from 10% in the mid-1980s. And many older adults stay in the workforce for health—not financial—reasons. One analysis suggests that retiring earlier is associated with higher mortality, finding an 11% reduction in risk of death for each additional year of work.

So how can today’s older adults slow down or leave their careers without losing their health?

“Retirement from work is not retirement from life,” said Zaldy Tan, MD, MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai. “It’s not like there is a universal, specific age at which our bodies shut down or our brains slow down to a halt. That is not physiological. This idea of retirement is man-made.”

The key factor, Tan said, is not retirement itself—but what people do after they stop working. Retirees who remain socially and cognitively engaged often experience better physical health, slower biological aging and improved mental wellbeing than those who do not, Tan said.

Elam is a perfect example. Her days still have structure and purpose: volunteering on her church’s fundraising committee, walking in Fox Hills Park, attending the opera and sharing Sunday dinners with family.

“I like to get dressed, give back to my community and make sure I have a full day,” Elam said.

Rosen said that sense of routine and purpose can make a big difference in how people experience retirement.

How to Prepare for a Healthy Retirement  

For many, a job gives more than income—it provides routine, purpose and daily social interaction. When the job disappears, the transition can be challenging, particularly for people whose relationships and activities revolve around the workplace.

“Work is sometimes seen as negative,” Tan said. “But we shouldn’t look at work as evil and vacation or retirement as good. It’s really what you make of both situations.”

Retirement can even improve the health of some—especially those leaving physically demanding or high-stress careers. Rosen said that some of her retired patients find they have more time to focus on exercise, cook healthier meals, spend time outdoors or explore new interests.

But Tan said the transition works best when people prepare for it.

“People spend years preparing to enter the workforce, but retirement requires discipline, too,” he said. “If your friendships and routines are centered on work, you need to start building activities, social connections and interests outside the workplace before you retire so you don’t end up isolated.”

Rosen recommends that people who are considering retiring take stock of where they find meaning in their lives—whether that purpose comes primarily from work or from activities, hobbies and relationships outside the workplace.

“What matters most are a patient’s individual goals and preferences,” Rosen said. “It really depends on the individual and what they find most meaningful in their life.”

For those who do retire, Rosen said maintaining structure and healthy habits is essential. She recommends aiming for at least 150 minutes of cardio each week and strength training twice a week. She also advises retirees to build social activities into their routines, such as volunteering or scheduling regular get-togethers with friends, to stay socially connected.

Mental stimulation is another important piece. Work often provides daily intellectual challenges, and Rosen said retirees benefit from replacing that engagement with activities such as continuing education, mentoring or doing memory exercises.

Elam, for example, reads every day and keeps her mind active with small mental exercises. If she can’t remember the name of something, she runs through the alphabet until a letter triggers her memory.

When Retirement Isn’t the Right Fit

For Christine Maclin, retirement simply wasn’t a good match.

Maclin, now 79, originally retired from her job as a cook at age 69, planning to rest and enjoy her free time. But after six months, she realized she missed the learning and sense of purpose that work provided.

“I mean, how many movies can you go to? How many coffee shops can you go to?” Maclin said. “I love hanging out with my friends, but ultimately I felt like retirement was time wasted.”

She returned to the workforce through a staffing company, first working as a cook for the Magic Castle and the University of Southern California—and later as an associate on the sales floor at Nordstrom. In January 2025, she decided to try something new and took a 10-week course in professional caregiving.

“What Christine has done—finding work and continuing to learn—shows that some patients fare better when they work,” Tan, Maclin’s physician, said.

Now Maclin works twice a week as a personal caregiver—cooking for her client, socializing and helping with errands—while continuing to learn something new every day.

“I like having somewhere to go and having something to do,” Maclin said.

Keeping a Positive Mindset, Retired or Working

Elam and Maclin each attribute their good health to a resilient, positive mindset.

Maclin says occasionally forgetting things is a normal part of life and not something worth getting upset about. Instead of becoming frustrated, she focuses on solving the problem, as she recently did one morning when she couldn’t recall if she had taken her medication.

“Instead of getting angry because you forgot something, solve the problem,” Maclin said. “I decided that after I take my medication, I just turn the container upside down, so I know.”

Elam says she tries to approach the aging process with as much style and grace as possible and avoids worrying prematurely.

Retired or not, she believes the key to staying healthy is simple: “Find activities you enjoy, and always be grateful,” Elam said.

Read more from Stories and Insights: Why Exercise Is Important as You Age

Obesity increases the accumulation of senescent cells, aged cells that have stopped dividing but have not died, in several organs and tissues.

“Senescent cells differ depending on the originating cell types, diseases and other factors. Some senescent cells help with wound healing, but others cause harm and are known contributors to age-related diseases,” said Masayoshi Suda, MD, PhD, assistant professor of Medicine at Cedars-Sinai and lead author of the study. “Our goal is to identify and target these harmful types of senescent cells while sparing helpful cells.”

Previous research by the investigators showed that eliminating senescent cells with drugs called senolytics improved metabolic function, the body’s method for turning food and drink into energy.

In the current study, investigators focused on senescent blood vessel cells. They selectively removed these cells from obese laboratory mice and found that the animals’ inflammation and fat mass were reduced—and blood sugar levels improved.

When the investigators transplanted senescent blood vessel cells into lean laboratory mice, those mice developed inflammation in fat tissue and metabolic dysfunction.

Suda said this occurred because senescent blood vessel cells release high levels of inflammatory molecules.

The investigators next treated both groups of mice with fisetin, a naturally occurring senolytic compound, and found that the mice had fewer senescent blood vessel cells and improved diabetic symptoms. Investigators saw a similar decline in senescent blood vessel cells when they treated tissue samples from obese human patients with fisetin.

“Preliminary findings like these are crucial to translating aging research into clinical care,” said James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics and senior author of the study. “While more research is needed, we aim to eventually treat multiple age-related diseases simultaneously by using fisetin and related senolytics for aging and metabolic health.”

Suda said his team will next work to test this approach in clinical trials.

“If we can target senescent cells safely in humans, it could help address not just diabetes but a range of age-related conditions,” he said.

Additional Cedars-Sinai authors include Selim Chaib, Larissa Langhi Prata, Tamar Pirtskhalava, Nino Giorgadze, Sara Espinoza, Nicolas Musi, and Tamar Tchkonia.

Additional authors include Yi Zhu, Utkarsh Tripathi, Karl Paul, Allyson Palmer, Vagisha Kulshreshtha, Christina Inman, Kurt Johnson, Runqing Huang, Carolyn Roos, Luisa Leon-Sanchez, Jordan Miller, Thomas White, Linshan Laux, Laura Niedernhofer, Paul Robbins, Sundeep Khosla and Stefan G. Tullius.

Disclosures: Tamar Tchkonia, Allyson Palmer, Yi Zhu and James L. Kirkland have a financial interest related to this research, including patents and pending patents covering senolytic drugs and their uses held by Mayo Clinic.

Funding: This work was supported by the US National Institutes of Health (NIH) grants R37AG013925, R33AG061456, P01AG062413 (J.L.K., S.K., L.J.N., P.D.R.), U54 AG079754 (P.D.R., S.K., L.J.N), P01AG43376 (P.D.R., L.J.N.), R01AG086085 (S.K.), R01AG087387 (Y.Z.), and R01 AG063543 (L.J.N.). 

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Healthcare professionals in the Healthspan Clinic concentrate on the prevention and treatment of age-related illnesses and disabilities like cognitive decline and impaired mobility. The clinic is open to patients 18 and older.

“Aging is the leading risk factor for developing multiple chronic conditions that diminish quality of life,” said Sara Espinoza, MD, medical director of the Cedars-Sinai Healthspan Clinic and a Gerontological Society of America fellow. “This unique clinic offers scientifically backed science with clinically proven treatment and lifestyle recommendations that can improve health and wellbeing—now—and as individuals age.”

While advancements in medicine like antibiotics, vaccines and childbirth care have increased the average U.S. lifespan, physician-scientists at Cedars-Sinai are more concerned with keeping patients healthy—not merely alive. The medical term is “healthspan,” and the clinic’s experts say their goal is to help adults stay healthy and independent as long as possible.

“To do so, it is important that our approach is guided by scientifically proven, evidence-based findings about the fundamental aging processes that are root-cause contributors to multiple disorders and diseases—in other words, the new field of geroscience,” said James Kirkland, MD, PhD, director of the Center for Advanced Gerotherapeutics at Cedars-Sinai.

Patients seeking care at Cedars-Sinai’s Healthspan Clinic participate in at least one in-person visit. Experts assess patients for physical and cognitive function, lifestyle factors such as diet and exercise, and overall health status.

Espinoza said these consultations are an opportunity to discuss healthy-aging goals and habits. Patients are provided guidance on lifestyle, such as diet, exercise and sleep quality. Patients in the Healthspan Clinic also can opt to participate in a biorepository that analyzes patients’ blood and other data to track biomarkers linked to the onset of diseases.

“This clinic is an opportunity to change the trajectory of a patient’s health before they have complex medical issues,” said Espinoza, also the director of the Center for Translational Geroscience at Cedars-Sinai, where investigators conduct clinical trials for medicines and lifestyle advances aimed at healthy aging.

Nicolas Musi, MD, director of Cedars-Sinai’s Diabetes and Aging Center and the Division of Endocrinology, Diabetes and Metabolism, and Kirkland are also part of the clinic and provide treatment recommendations for metabolism, endocrinology concerns, and questions regarding interventions that potentially affect fundamental aging processes.

Espinoza said Healthspan physicians can refer interested patients to geroscience clinical trials at Cedars-Sinai or through the Translational Geroscience Network—an international consortium studying the biology of aging to prevent, delay or treat age-related diseases.

The network comprises 90 clinical trials across the U.S. and northern Europe and is led by Kirkland. The National Institutes of Health recently renewed the Translational Geroscience Network grant, awarding nearly $3 million over the next four years.

“The NIH renewal allows the network to keep studying a range of conditions that accelerate aging, including long COVID, obesity and Alzheimer’s disease, to ultimately find new ways to help people age in better health,” Kirkland said.

As the Healthspan Clinic grows, Espinoza also plans to hire physical trainers and dietitians to help curate personalized diet and exercise plans for patients.

To make an appointment with the Healthspan Clinic, call 310-423-3870 and select option 1.

Read more from Discoveries: The Future of Aging Research

The Centers for Medicare & Medicaid Services (CMS) recently selected the Cedars-Sinai CARES (Care Management/Alzheimer’s Expertise/Resources/Education/Social Support) Program for dementia patients and their caregivers as a Guiding an Improved Dementia Experience (GUIDE) Model site. The Cedars-Sinai CARES Program is among 14 established programs in California, and it is one of only two in Los Angeles selected by CMS for the established program track. 

Additionally, the medical center’s comprehensive outpatient Geriatrics Program for people 65 and older, along with its Bone Health Coaching Program, recently received Age-Friendly Health System Committed to Care Excellence recognition from The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States. Cedars-Sinai also is among just 30 hospitals nationwide recently selected to join the new Age-Friendly System-Wide Spread Collaborative, which aims to accelerate adoption of evidence-based, high-quality care for older adults across all the medical center’s sites and care settings.

“Cedars-Sinai cares for more patients over 80 than any other academic medical center in the country, so operating under an age-friendly healthcare model is critical to our continued ability to serve our growing community of older adults,” said Bryan Croft, the hospital’s executive vice president and chief operating officer. “In just over a decade, the U.S. will have more people over age 65 than children, for the first time in history. An aging population has unique care needs, and these recognitions further demonstrate that Cedars-Sinai is the premier institution to provide this level of outstanding care.”

Cedars-Sinai Medical Center first received the Age-Friendly Health System Committed to Care Excellence designation in 2020.

Age-Friendly Health Systems integrate the “4Ms” of care: what matters most to each patient, medication safety, mobility and mentation, or mental functioning.

“Integrating the ‘4Ms’ framework into models of care for older people is about providing optimal care and measures of safety while addressing what’s most important to each individual patient,” said Sonja Rosen, MD, chief of Geriatric Medicine. “You can’t assume that everyone’s goals and preferences are the same. At Cedars-Sinai, we strive to help people live as healthy and high-functioning as possible for as long as possible and at the same time, achieve their goals.”

Cedars-Sinai’s outpatient Geriatrics Program has geriatricians who treat patients throughout the community for geriatric syndromes and primary care needs. This includes conducting consultations for falls, osteoporosis, polypharmacy—which is taking five or more medications—dementia, social isolation, loneliness, and other topics of importance for many older adults.

The hospital’s outpatient Bone Health Coaching Program, part of the Geriatric Fracture Program in the Department of Orthopaedics, provides bone health assessments and counsels patients on how to reduce the risk of fragility fractures, often caused by poor bone quality associated with older age, reduced mobility and some medications. Poor bone quality is often a surprise to older adults – unless they are screened, they may not be aware. According to the U.S. Centers for Disease Control and Prevention, falls that cause fragility fractures are a primary cause of injury in people 65 and older and often lead to hospitalization, loss of independence and even death. 

“We aim to help preserve good quality of life and independence for our patients," said nurse practitioner Kathleen Breda, MSN, associate director of orthopaedic Clinical Programs. “We’re proud that our Bone Health Coaching Program has connected more than four times the national average of patients with bone health care and is an important element of our age-friendly model of care." 

The CARES Program at Cedars-Sinai provides comprehensive dementia care management for patients with Alzheimer’s disease and other dementias as well as support and training for their family caregivers.

With the CMS selection of the CARES Program as a GUIDE Model site, eligible Medicare patients in the program can access $2,500 annually for adult day care, in-home care and facility care expenses when they need additional help—for example, after a hospital stay or during times of decreased caregiver availability.

Patients in the moderate to late stages of dementia also will receive a CARES Program home visit to help evaluate their needs, ensure safety and promote sustainability of in-home care. Educational offerings for caregivers are also provided.

“The selection of our CARES Program as one of the CMS GUIDE established care sites is a testament to the high quality of care that we provide to patients with memory impairments and the support we provide to family caregivers of dementia patients,” said Zaldy Tan, MD, MPH, director of the CARES Program and the Jona Goldrich Center for Alzheimer’s and Memory Disorders. “We continue to see improved health outcomes in vulnerable patients who are enrolled in the program, and as a GUIDE Model site, we expect this to be further enhanced.”

Read more from the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know

The findings are published in JAMA Network Open.

The development and use of medications to treat acute and chronic health conditions has improved longevity and quality of life. But for some older adults, taking multiple medications can do more harm than good. Polypharmacy—the use of five or more medications—is associated with a higher risk for falls, fractures, hospitalizations, along with functional and cognitive decline for some aging patients.

“Polypharmacy, especially harmful or inappropriate polypharmacy, is bad. But the research community hasn’t figured out how to consistently move the needle on hospitalizations, quality of life, mortality and other adverse outcomes associated with being on several medications at once,” said corresponding author Michelle Keller, PhD, a health services scientist in the Department of Medicine at Cedars-Sinai.

Investigators analyzed 14 studies that systematically evaluated various tactics used to address the risks of taking five or more medications. They could not find a clear set of practices that consistently helped polypharmacy patients, but some approaches showed promise.

“Intensive, face-to-face interventions were effective in some studies. In those cases, having a healthcare provider review the patient’s medical record, go over the drugs with them to discuss medication adherence or whether a drug was still appropriate, and providing patient education all appeared to reduce hospitalizations,” said senior author Joshua Pevnick, MD, co-director, Division of Informatics at Cedars-Sinai.

Adults 65 and older tend to take more medications. According to a report by the Centers for Disease Control and Prevention, about a third of adults in the U.S. who are in their 60s and 70s take five or more prescription drugs. Medications to control cholesterol, high blood pressure and diabetes are the most common.

“We must weigh the benefit of prescribing a new medication against the possible risk it may present. Can it interact with other medications the patient is taking or impact the disease course in the older adult? For example, a new medication may effectively treat a specific condition but make the person drowsy, putting them at higher risk for a fall or impair their cognitive abilities. The more tools we develop to help us assess the risk-benefit of medications for our patients, the better care we can give them,” said  Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

While time spent discussing medication use with a healthcare provider, in person, did reduce some negative polypharmacy consequences in a few studies, a simple consult with a pharmacist also proved protective in some cases.

“Older adults often develop a good rapport with their pharmacists, and in some of the studies we reviewed, relatively short consults with them were very helpful to polypharmacy patients—especially those who may be at risk for falls or cognitive decline. I think a lot of health systems are recognizing the important role a pharmacist can play in the overall healthcare of their patients,” Keller said.

Identifying who is at higher risk for adverse polypharmacy outcomes is critical in order to develop effective interventions and is the focus of a pilot program in development at Cedars-Sinai.

“We want to create a risk-prediction model using data from the electronic health records of patients seeing primary care physicians. For the polypharmacy patients we identify as being at high risk for health problems associated with their medication regimen. As a first step, we can flag the record and send a message to their physician recommending a consult with a pharmacist, as a first step,” Keller said.

The Cedars-Sinai pilot program is expected to begin this spring.

Funding: This work was supported by National Institutes of Health grant numbers K01AG076865 and K24AG047899.

Follow Cedars-Sinai Academic Medicine on X (Twitter) for more on the latest basic science and clinical research from Cedars-Sinai.

Read more on the Cedars-Sinai Blog: The Balancing Act of Fall Prevention

“This season can be particularly difficult for older adults who don't have as many social connections, or are hindered by physical limitations, because of all the messaging around us that emphasizes activity and connectedness,” said Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

The Surgeon General of the United States has described loneliness and isolation as an epidemic affecting 50% of the population and associated with a higher risk for cardiovascular disease, dementia, stroke, depression, anxiety and death.

“Loneliness and isolation, part of what we call ‘social determinants of health,’ are established risks for poor health and early death, especially for aging adults. The health risks are equivalent to smoking  up to 15 cigarettes a day,” said Cedars-Sinai geriatrician Allison Moser Mays, MD, MAS.  “But we also know that being more socially connected can actually decrease the risk of mortality by as much as 50%.”

Hearing loss, memory impairment, the inability to drive safely and other functional changes that can come with age impact the desire or ability to attend holiday gatherings and can exacerbate feelings of loneliness and anxiety.

“We see a lot of our patients not want to go out as much because they are unable to communicate well. Large gatherings of family or friends or just going out to a restaurant with others can be very stressful if they are straining to hear or have difficulty following conversations. They may prefer to stay at home and isolate rather than feel out of place or anxious,” said Mays, an assistant professor of Medicine.

Grief and loss can also be significant drivers of social isolation and loneliness as people age.

“This can be a particularly difficult time of the year for anyone who has experienced loss or who doesn't have that sense of community they wish they had. And that really is what defines loneliness—not having the social connections that you want,” Mays said.

Geriatricians at Cedars-Sinai routinely discuss loss and grief during patient visits and can provide referrals to social workers or grief support groups.

“If you know that an individual is feeling lonely, if they've shared that they wish they weren’t so alone and want help, then see if there are hurdles that are keeping them isolated, such as lacking transportation or feelings of grief and loss. Find out what you can do to help them,” said Rosen, a professor of Medicine.

Ways to Support Older People During the Holiday Season

1. Initiate: Check in more often with older family members and friends and gently ask how they are doing and offer support. A phone call can go a long way in nurturing connectedness.
2. Invite: Consider inviting them to smaller, more intimate, gatherings if functional limitations are an issue. Welcome them without pressuring them to fit into your plans.
3. Listen: Actively listen when they want to talk, even if it is a difficult conversation.
4. Accommodate: Discuss an activity or simple pleasure they would enjoy rather than insisting they participate in planned events.
5. Grieve: Loss is felt deeply during the holidays. Pay attention and let them know you are there to listen. Meet them where they are and do not force activities they may be anxious about.

Cedars-Sinai’s Leveraging Exercise to Age in Place (LEAP) is an evidence-based exercise program proven to decrease loneliness, social isolation and the fear of falling in older adults.

“We’ve found that purpose-driven activity is a good way to form community. In our LEAP program exercise classes, some of the participants were only coming 40% of the time, but they still felt they had a sense of community and connection to the class,” Mays said.

Loneliness and social isolation do not have to be the theme of this holiday season.

“A lot of people are embarrassed to ask for help. They’re embarrassed to be alone. But they need to know that most of us struggle with the same things at one time or another. We are all part of the same community. There is help and comfort, and we can be there for one another,” Rosen said.

Read more on the Cedars-Sinai Blog: Anxiety in the Golden Years: What You Should Know

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

By 2030, there will be more than 70 million people over the age of 65 in the U.S., according to the U.S. Census Bureau. Because of a shortage in geriatricians, most of the healthcare for older adults in the U.S. will be provided by physicians in other specialties.

To address that gap, Cedars-Sinai and other age-friendly health systems create programs that focus on the “4Ms”: what matters most to older patients, patient mentation (mental functioning), patient mobility and medication safety. "By doing so, really in any program, we're going to help ensure that we're providing optimal care for our older patient population without necessarily having a geriatric provider directly providing that service,” Rosen told Ansari.

A good example, Rosen said, is Cedars-Sinai’s Geriatric Fracture Program, a collaboration of the Department of Orthopaedics and the Geriatric Section of Cedars-Sinai’s Department of Medicine. This program focuses on decreasing time to surgery for older adults who come to the hospital after experiencing a significant fracture, and ultimately decreasing their length of stay, Rosen told Ansari. When enrolled patients leave the hospital, clinicians follow up to assess the patient's bone health and develop strategies for future fall prevention.

In a recent study of the program, authors examined the health records of patients 65 and older with non-spine traumatic fractures who were cared for by physicians at Cedars-Sinai Medical Center. Investigators compared data from 746 patients who participated in the Geriatric Fracture Program with data from 852 patients who were not enrolled in the program.

The findings, published in a Health Services Research special issue on aging, showed that patients enrolled in the Geriatric Fracture Program experienced 2.12 fewer days in the hospital, a significant difference. Hospitalization also cost an average of about $5,000 less for program participants compared with patients not in the program. 

“We really focused on how to make sure that when patients leave the hospital, they still have their bone health … and strategies for future fall prevention have been addressed so that these things don’t happen again,” Rosen said.

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