Department of Geriatrics and Palliative Medicine

The department of geriatrics and palliative medicine is dedicated to enhancing healthcare and quality of life for older adults and individuals with serious illnesses.

About

Program Overview

We believe it is important for everyone to learn about the issues involved with health care and quality of life for older people and those with serious illnesses. Whether you're a medical student, fellow or graduate student, we train you through integrated clinical care, academics and research. We offer intensive, round-the-clock care for hospitalized patients at Carilion Roanoke Memorial Hospital and manage the pain and discomfort of patients at other facilities upon the request of their managing physician. Instruction in Geriatrics and Palliative Medicine is a required element of the Virginia Tech Carilion School of Medicine. In addition to our geriatric medicine and hospice and palliative medicine fellowships, we also offer training to practicing physicians and other hospital staff members who aim to expand their knowledge of integrative care of older adults and adults experiencing advanced illness. Our approach to care utilizing an interdisciplinary palliative care team prepares learners to become leaders in geriatric and palliative care in hospital-based and private settings. 

Virginia Tech Carilion Partnership

Our partnership includes faculty for the pre-clinical and clinical students at VTC School of Medicine; mentors for student researchers; serving on various VTC governance committees; partnering with student interest groups (e.g., humanism and ethics groups and history of medicine); leading the narrative medicine elective; and hosting student electives on long-term care, palliative medicine and ethics.

Virginia
Provide excellent patient care to serve our communities.
Teaching
Dedicated to teaching the next generation of medical students.
Shooting Star
Embrace the full scope of geriatric and palliative medicine from aging well to approaching the end of life.

Mission, Goals and Strengths

We are a group of professionals dedicated to providing high-quality clinical care to individuals facing the challenges of advanced illness in late life, to include end-of-life care. We serve as instructional leaders for undergraduate and graduate medical education and provide community education on topics related to aging, supportive care and end-of-life care. We are striving to expand our research contributions to improve the care of older adults and those suffering from advanced illness.

Message from Leadership

Welcome to the Geriatrics and Palliative Care service. We are a group of professionals dedicated to providing high-quality clinical care to individuals and families facing the challenges of advanced illness in late life, to include end-of-life care. To meet these diverse needs, we embrace a medical and social model of care: using the power of medicine and community to bring healing to the suffering.

Patient care is our focus. Our palliative care service provides inpatient and outpatient care for patients suffering from advanced illness. Our geriatric psychiatrists support older adult patients and families in a clinic and facility-based practice, focusing on the common mental health needs encountered in late life. Our geriatricians serve in a variety of roles as attending physicians and medical directors at several community nursing homes, as consultants at Carilion Roanoke Memorial Hospital and at the Center for Healthy Aging. In addition, our expertise as geriatricians or palliative care physicians is applied in clinical and leadership roles for Carilion Clinic Home Care and Hospice.

Our expertise and talents in geriatric and palliative medicine are also exercised across the spectrum of medical education. Our faculty members lead clinical interviewing courses at the Virginia Tech Carilion School of Medicine (VTCSOM), precept students on their third-year clinical rotations and lead elective fourth-year courses. Faculty members instruct Internal Medicine and Family Medicine residents for their required clinical rotations and electives, as well as provide instruction for our fellows in our Palliative Medicine and geriatric fellowship programs.

Patients want to remain in their homes and community when experiencing advanced illness. Our section is dedicated to using existing and emerging systems of care to support patients and families through challenging times.

"The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience. - Eleanor Roosevelt"

Brian K. Unwin, MD, Chief, Geriatrics and Palliative Medicine

Brian K. Unwin, MD, Chief, Geriatrics and Palliative Medicine

Department specs

Carilion Clinic’s Department of Geriatrics and Palliative Medicine offers an interdisciplinary approach to care that specializes in treating patients living with chronic, serious illness. We specialize in adult care, Alzheimer’s disease, bioethics, disability, driving assessments, symptom management, advance care planning, falls and frailty. In addition, we offer a Geriatric Assessment Clinic, Memory Disorder Clinic, Geriatric Psychiatry, Home Care services and Hospice care, home visits, and inpatient and outpatient geriatrics and palliative care consultation. We also specialize in normal aging, nursing home care and skilled nursing facility care.

Program Size

  • Geriatric Psychiatry: 2 physicians
  • Geriatrics: 8 physicians, 5 ACPs, 2 social workers (1 M.S.W. and 1 L.C.S.W.), 2 R.N.s, 1 L.P.N., 1 Ph.D. psychologist
  • Palliative Medicine: 5 physicians, 1 clinical nurse specialist, 1 M.S.W., 1 bereavement counselor, 1 ACP
  • 1 heath care administrative assistant, 1 administrative coordinator
  • Hospice: 2 physicians, 2 ACPs

Quality Measures

  • Board-certified, residency-trained faculty physicians
  • Fellowship training in geriatrics, geriatric psychiatry or palliative medicine
  • Certified medical directors in long-term care medicine or hospice care

Services

  • Comprehensive geriatric psychiatry (inpatient, outpatient, long-term care and memory support units)
  • Comprehensive palliative care (inpatient consultation, inpatient palliative care unit, outpatient clinic and hospice care)
  • Comprehensive geriatrics consultation services (inpatient consults, outpatient consults, long-term care and skilled nursing facility medical directors and attending physicians, home visit consultations/geriatrics assessments)
  • Medical directorship for Carilion Clinic Home Care and Hospice

Clinical Interests

  • Palliative medicine
  • Hospice care
  • Home health care
  • Skilled nursing facility and long-term care
  • Medical education
  • Dementia care and caregiver support
  • Geriatric psychology
  • Home-based care
  • Community collaboration
  • Bereavement counseling and psychosocial support for families

Conditions Treated

  • Advance care planning
  • Behavioral disturbances in dementia
  • Caregiving and other psychosocial considerations
  • Community-based care
  • Delirium
  • Dementia
  • Depression and other mood disorders
  • Ethics
  • Falls
  • Frailty
  • Healthy aging
  • Hospital care
  • Nursing home care
  • Palliative care
  • Pharmacotherapy
  • Physical activity
  • Pressure injuries and wound care
  • Prognostication
  • Rehabilitation
  • Schizophrenia spectrum and other psychotic disorders
  • Stroke and cerebrovascular disease
  • Transitions of care

Awards

  • Leonard Tow Humanism in Medicine Award
  • Best Bedside Manner Awards for multiple faculty
  • Best Outside Faculty Award in Family Medicine
  • Multiple Physicians Rated Top Geriatric Doctor in The Roanoker Magazine
  • Multiple Physicians Rated Top Palliative Medicine Specialist in The Roanoker Magazine

Areas We Serve

  • Roanoke
  • New River Valley
  • Video/telehealth/e-consult support for Lexington and Giles, Tazewell and Franklin counties

Contact and Careers

Contact

For inquiries about careers in the Geriatric and Palliative Medicine department at Carilion Clinic, contact Brian Unwin, M.D., Chief, Geriatrics and Palliative Medicine, at bkunwin@carilionclinic.org.

Publications

Multiple-Instance Learning for Sparse Behavior Modeling from Wearables: Toward Dementia-Related Agitation Prediction

Agitation in persons with dementia (PWD) poses major health risks both for themselves and for their caregivers. Passive sensing for continuous behavior tracking...

BESI: Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment: Phases 1 and 2

Caregiver burden associated with dementia-related agitation is one of the most common reasons a community-dwelling person with dementia (PWD) transitions to a c...

End-of-Life Care of Persons With Alzheimer's Disease: An Update for Clinicians

While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer's disease and other...

Comparing No-Show Rates of Neurology Outpatients With and Without Parkinson's Disease: A Real-World Assessment of the Parkinsonian Personality Profile

Parkinson's disease (PD) has been hypothesized to be associated with certain personality traits, including conscientiousness and punctuality. However, research ...

Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals

As ongoing research explores the impact of moral distress on health care professionals (HCPs) and organizations and seeks to develop effective interventions, va...

Tools for Better Dementia Care

Alzheimer's disease is the sixth-leading cause of death in the United States, and one in three American seniors dies of some form of dementia. Caring for adults...

Pain Management Pillars for the Clinical Nurse Specialist: Summary of National Association of Clinical Nurse Specialists Opioid/Pain Management Task Force

This article describes the work of the National Association of Clinical Nurse Specialists (NACNS) Opioid/Pain Management Task Force and provides guidance for th...

Research

The Behavioral and Environmental Sensing and Intervention Study (BESI) is a four-year research project funded by the National Science Foundation that examines how wearable technology and environmental sensors can provide information that helps soothe agitation in people with dementia. Carilion Clinic is one of 200 research sites that took part in the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study, a partnership between the Alzheimer's Association and the American College of Radiology. This two-year study was not just about finding a specific treatment; it focused on improving the standard of care for those with Alzheimer's disease or other forms of dementia. It was completed in 2019. We also have ongoing scholarly articles.

Finding Treatments and Solutions for Dementia Patients and CaregiversIDEAS Study Delves Deeper Into Treatment of Alzheimer's
See more

Education

Overview

Carilion’s dedication to the care of vulnerable adults and children is demonstrated in its commitment to support three fellowship programs within our section. Beyond providing clinical care, fellowship graduates serve as educators, leaders and advocates within our community to assist those in need.

The Virginia Tech Carilion School of Medicine (VTCSOM) is a unique allopathic medical school that employs a problem-based curriculum with a particular emphasis on competency with medical research. Located adjacent to Carilion Roanoke Memorial Hospital, the school not only rounds out Carilion's transformation to a clinic model, allowing us to provide superior patient care, cutting-edge research and education, but it also provides those in the Geriatrics and Palliative Medicine department with exciting growth opportunities.

We offer three fellowships in Hospice and Palliative Medicine, Geriatric Medicine, and Geriatric Psychiatry. Our Hospice and Palliative Medicine fellowship prepares physicians for leadership roles in clinical and academic palliative medicine as well as for medical directorships within hospice programs. This fellowship offers three dimensions of education: clinical, academic and research. Training is provided in diverse settings of care, including an academic tertiary care referral hospital; a Veterans Affairs medical center; an outpatient clinic; and homes in urban, suburban and rural settings. Our Geriatric Medicine fellowships have been in existence for over 15 years. We believe our curriculum prepares graduates to be 21st-century geriatricians. We have graduates who are practicing Geriatric Medicine in academic and private practice settings. 

Our grand rounds focus on new, novel or emerging interests/developments within Geriatrics, Hospice and Palliative Medicine. Examples of topics include hospital at home, applications of medical marijuana and physician-assisted suicide.