newsmaker: Knight Steel, MD
media coverage: The Star-Ledger

Knight Steel, MD, Hunterdon Endowed Professor of Geriatrics at UMDNJ-New Jersey Medical School

A Knight With a Cause
(But No Armor)

by Mary Ann Littell

Ask many gerontologists why they chose their specialty, and they'll say their motivation was a close relationship with their grandparents. Not so for Knight Steel.

"I loved my grandparents, but it's not why I went into geriatric medicine," he says. "I chose it because I was annoyed at the quality of care given to older people. For me, it was a moral issue. They deserve much better."

Steel has spent his entire career championing medical care for the elderly. He has cared for them, done research on geriatric issues, and written extensively for professional journals. He also has his own weekly column, "Senior Health," which appears in The Star-Ledger.

"It's more challenging than you would think to write a weekly column," he says. "But it is a good way to get information out to people who may not be seeing a physician on a regular basis." The column covers specific health concerns as well as "quality of life" issues. Some recent topics include kidney stones, dementia, medication management and problems with balance. He hears from readers regularly.

Steel has been in on the ground floor of geriatric medicine since his early years on the faculty at Boston University (BU) School of Medicine. He likes to tell a story about attending a reception in Boston in 1977, along with faculty members from all the medical schools in the city. One of them approached Steel, then a new arrival, and asked what he did. When Steel replied, "I'm interested in geriatrics," his questioner looked at him quizzically. "Jerry who?" he asked.

Steel explains, "At that time, geriatrics had a low profile. But there was a lot of discussion about where it fit into the scheme of things. Did geriatrics need to be a specialty? Many physicians said they'd been caring for the elderly for years, so was this really necessary?"

His response, then and now, is that it is a true specialty and should be recognized as such. He points out that in the U.S. today there are more long-term care beds than acute care beds. At Hackensack University Medical Center, where he is director of the Homecare Institute and chief of geriatrics, some 40 percent of the "bed days" are currently reimbursed by Medicare, and that number is growing.

As he wrote in a recent article: "Today, geriatricians have become spokespersons for the principle that care must be person-specific and not site-specific...A whole series of issues have come to be recognized as essential to medical care. Falls, delirium, incontinence, and of course, polypharmacy are recognized for their importance even by physicians outside our area of interest."

Steel's interest in geriatric medicine began during his residency in Chapel Hill, NC, where he met his early mentors. He had just graduated from Columbia University College of Physicians and Surgeons, and was newly married.

Steel and his wife stayed in the home of the retiring chair of medicine, Charles Burnett, MD, when he traveled abroad, and looked after his children. To this day, they have maintained an enduring friendship with his daughter.

Steel served as chief resident under Louis Welt, MD, Burnett's successor, one of the founders of modern-day nephrology. He also had the good fortune to work with T. Franklin Williams, another well-known nephrologist and authority on diabetic nephropathy. When Williams moved to Rochester, NY, to become the medical director of the Monroe County Hospital, he asked Steel to be his deputy. Steel joined him in 1972. The thousand-bed hospital, located on the banks of the Erie Canal, was considered so insignificant that it did not even appear on many maps of the city.

Together, the two physicians built a highly-regarded program in geriatric medicine. They also established the first acute care unit within a long-term care facility and one of the first multi-disciplinary assessment clinics.

Steel went to Boston in 1977, where he was the first professor of geriatrics at BU. He became chief of geriatrics and directed the Gerontology Center, which encompassed all activities in aging throughout the university. He also redesigned the house calls program for geriatric patients. "The fourth year medical students as well as all the residents had an obligatory rotation on the service," he says. The program made 7,000 home visits a year. Steel's contributions to the school were considered so noteworthy that BU established an endowed prize - the Knight Steel Award - in his honor.

In 1991, Steel accepted a position as Chief, Health of the Elderly Programme for the World Health Organization (WHO), and he and his wife moved to Geneva, Switzerland. "We traveled all over the world," he says. "It was a phenomenal experience." After a few years, they returned to the U.S. to be closer to their two grown daughters. One daughter has a PhD in mathematics, lives in Seattle, and works for NOAA (the National Oceanic and Atmospheric Administration). The other is a PhD student at Harvard.

The physician came to UMDNJ-New Jersey Medical School in 1995 as the Hunterdon Endowed Professor of Geria- trics. An advocate of home care for many years, Steel recently started a house calls program which is modeled after the one in Boston. The multidisciplinary program has three physicians, two advance practice nurses, and two fellows, who, along with medical students and house staff, make home visits in the area. Steel is involved in a wide range of other projects, all serving the needs of the elderly. He's on the board of the Kendal Corporation, a not-for-profit organization that develops residential communities and services for older people. Many of the communities are in college towns and have strong relationships to the schools. Kendal communities are located in Ithaca, NY (near Cornell University and Ithaca College), Hanover, NH (near Dartmouth College), and other cities. Steel says, "There's a certain vitality in a college town, and the residents are able to tap into that, taking classes and attending sporting events."

Steel is also a co-founder and member of InterRAI, a not-for-profit network of researchers in more than 20 countries committed to improving health care for persons who are elderly, frail, or disabled. He's been president of the American Geriatrics Society and was among the first persons awarded the Geriatric Medicine Academic Award by the National Institute on Aging.

The physician predicts that geriatrics will become more influential in virtually all adult specialties. "Before too long, all the specialties and subspecialties - orthopedics, anesthesia, general surgery, you name it - will have a geriatric component," he says. "So you'll have the option of becoming a geriatric orthopedist, anesthesiologist or surgeon." Within five years, he believes, there will be boards for these sub-specialties.

And he should know. He was the chair for the first national examination in geriatric medicine for the American Board of Internal Medicine and the American Board of Family Practice.

"I'm doing whatever I can to attract good physicians to geriatrics," he says.