The Inflection Point in Care for Older Adults: Transforming Care for America’s Aging Population

For decades, healthcare in America has operated on a simple premise that more care meant better care. With the availability of more procedures, more tests, and more specialists the assumption is that with more treatment leads to better quality care. While this approach is logical, is it the most compassionate care we can provide when it comes to caring for our most vulnerable populations?

Consider this scenario: A 95-year-old gentleman who has significant dementia, lives alone, but can still navigate his familiar patterns at home. He gets up each morning, uses his walker safely, and lives comfortably with consistent caregivers who know his routine. When a minor medical issue arises, the instinctive response is clear: get him to the hospital. After all, hospitals are the safest place to go when something is wrong. But what happens when the opportunity cost of going to the hospital is a risk of greater consequence?

Dr. Diane Wintz, Medical Director of Trauma and Generational Health at Sharp Memorial Hospital in San Diego, has witnessed this scenario countless times. She’s coined a term for it: “medical inflection”. It’s the point where continued medical intervention may not be aligned with the patient’s priorities.

“There is not a treatment option, or there’s not a diagnosis or therapy that addresses whatever that vulnerability or social determinant of health is,” Dr. Wintz explains. “Then you’ve reached that point of medical inflection.”

In this scenario, clinical teams face a common challenge: when a patient with advanced dementia is stable at home, is being admitted to the hospital the right treatment for the patient? Acute care settings, with their noise, irregular routines, and unfamiliar faces, can easily destabilize a dementia patient who relies on patterns. If not considered carefully, a hospital admission can carry a risk of delirium, functional decline, and behavioral disturbances.

“We have to ask ourselves,” Dr. Wintz reflects, “is the hospital the right environment for someone like that?”

For older adults especially, there comes a moment when the trajectory of “more care” stops improving outcomes and begins causing harm. It’s the point where an additional test leads to an incidental finding that triggers a series of unnecessary interventions. Where a hospital stay results in delirium and functional decline. Where aggressive treatment aimed at extending life actually diminishes the quality of life.

We are now facing the reality that the traditional approach of “doing more” is not always sustainable. In some cases, the very interventions designed to help may unintentionally lead to more complications rather than prevent them. 

Dr. Wintz witnesses this paradox regularly in her clinical practice. But she also lived it personally with her own father, Jay. After a heart attack at 50, her father underwent extensive cardiac surgery and was told that future surgical options would be limited due to the reconstruction of his chest. Twenty years later, when his heart failed abruptly, the medical team turned to what they knew best: temporary interventions and machine-driven life support.

She became the medical liaison, guiding the medical team and her family to recognize that more treatment did not mean better outcomes. She recognized that extending his life through intensive medical interventions would not have given her father the kind of life he wanted in his final days.

This experience continues to shape her clinical work and advocacy for a care model that recognizes a key turning point in treating older adults: when it’s time to shift from aggressive treatment to thoughtful, personalized care.

This medical inflection point calls for a new approach to care, one that prioritizes the right care over more care. It means delivering reliable, timely, and personalized treatment that reflects what matters most to each patient and their family. This shift requires us to also embrace a counter-intuitive truth - that sometimes doing less means doing what’s better for the patient.

Innovations in Care

In 2019, Dr. Wintz launched a pilot program at Sharp Memorial Hospital that focused on geriatric trauma patients. Through this program, they were able to reduce delirium from double digits to zero, and decreased time to mobilization by 24 hours. The secret wasn’t about revolutionary new technologies or advanced medical interventions, but rather in the recognition that recovery depended more on getting patients moving, preventing confusion, and maintaining a patient’s ability to perform daily activities.

This approach required a shift from a physician-led effort to refocusing on multidisciplinary teams to support patients. Occupational therapists, physical therapists, speech pathologists, respiratory specialists, chaplains, and even art therapy and pet therapy programs became equal partners in patient care. Each discipline designed their own intervention, taking ownership of patient outcomes. The result? Over 50% of patients who come through Sharp’s Generational Health Program now discharge directly home, over double the rate among unenrolled patients.

Seeing the impressive results and recognizing that all patients could benefit from this approach, the West Health Institute partnered with the team at Sharp Memorial to extend this approach throughout the hospital. West Health Institute’s Chief Strategy Officer Jon Zifferblatt explains,

“The team at Sharp Memorial has developed and implemented one of the most comprehensive hospital programs to date and are pioneering best practices for the San Diego community. We are proud to partner with them in advancing innovative models of care for older adults, and together, our work will help provide a blueprint of excellence in geriatric care helping other providers make the meaningful shift to patient-centered care focusing on the right care, at the right time, in the right place.”

This program now exists in all hospital units at Sharp Memorial with a plan to expand throughout Sharp HealthCare’s system.

The success of Sharp’s Generational Health program also illuminates a broader truth about healthcare innovation: the most impactful changes often come from questioning fundamental assumptions about how care should be delivered. By asking, “What does this older adult actually need to thrive?”, rather than, “What medical intervention should we provide?”, the focus shifts from a disease-oriented approach to a person-centered one. Where healthcare has been trained to see problems to fix, this shift allows providers to meet patients where they are, to see what their patient really needs in their own environments, with their own routines, surrounded by what makes them feel safe and whole. 

“Sometimes doing nothing is actually the more heroic thing to do,” Dr. Wintz acknowledges. The decision to do less and refocus on what the patient really needs is done thoughtfully and compassionately by the clinical team. Dr. Wintz has found that many families find relief when medical inflection is honestly discussed. They’re grateful to avoid aggressive interventions that won’t improve outcomes and may cause more harm than good.

As part of Sharp’s Generational Health Program, their Geriatric Emergency Department embodies this shift from doing more to doing what’s right for the patient by prioritizing safety, comfort, and coordinated care. Rather than defaulting to hospital admission, these specialized units work to uncover what older adults truly need: medication adjustments, fall prevention strategies, social support connections, or simply reassurance that they can safely return home with the right resources in place.

This is the medical inflection point in action. It’s the pivot from playing defense against aging to designing systems that help people thrive through it. It’s not always about doing more; it’s about doing what’s better for the patient. Sometimes the most profound medical intervention is knowing when continued medical intervention is not aligned with the patient's best interests and priorities and having the wisdom to step back and focus on comfort, dignity, and the patient’s true needs.