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Dr. Leon Kraybill playing pickleball at Stauffer Park in Lancaster on Friday, April 22, 2022. He says exercise has proven benefits for those over 65.

Editor's note: This story appeared in Senior Living section of the May 11 edition of LNP.

Dr. Leon Kraybill is hoping to follow in the longevity footsteps of his father, who recently died at the age of 99. But that doesn’t mean the 63-year-old isn’t thinking about the inevitable.

“I’ve laid out my advance care planning, put it on a spreadsheet,” Kraybill says. “I have seen the wisdom of deciding what I want and laying that out for my family members and being precise about that. I will absolutely not go multiple times to the hospital and do multiple tests that will give me a week or a month of life at a great cost.”

As geriatrics division chief for Penn Medicine Lancaster General Health Physicians Geriatrics, Kraybill meets aging face to face every day. He cares for those with more complicated medical conditions, many of whom have a short time frame till the end of life. Over the years, more than a few have been role models of sorts, helping him figure out how he might approach his own aging — and death.

However, caring for those closer to the end of life was not how he began his career.

Kraybill grew up in Elizabethtown and jokes that he didn’t get very far in life (physically, that is) since he’s still practicing medicine in his hometown. After earning his medical degree from Temple University, he did his family practice residency at LGH.

“I chose to specialize in family practice following medical school because I admired the family practice doctors that I met,” he says. “I found them to be approachable and down-to-earth people who care deeply about their patients.”

He also liked the fact that family physicians deal with diverse medical issues and see the connection between medical and emotional health, he says.

However, working with older nursing home patients inspired Kraybill to make a midcareer shift 20 years ago and seek additional training through a geriatric fellowship at LGH. The switch to geriatrics put him in a relatively small fraternity in the medical world. Currently, there are fewer than 8,000 geriatricians in the United States, a somewhat surprising statistic considering the U.S. Census Bureau projection that older adults will outnumber children for the first time in U.S. history by 2034.

“Historically, geriatric care is not sexy or prestigious,” Kraybill says. “There is the stereotype of the older individual as complaining and complicated and all you’re doing is managing bowel medications. That sometimes does not entice younger physicians.”

And, it’s also not true, he says.

Geriatrics is about more than treating multiple medical conditions like hypertension, diabetes and heart disease. It’s about treating the patients and their families as individuals, he says, and recognizing that their health includes not only medical conditions but also mental health and psychosocial issues. Geriatrics is also about unanticipated opportunities, Kraybill says, noting he became a clinical infectious disease expert thanks to COVID-19 and its effect on the elderly population.

“Patients rarely expect me to perform miracles and cure them of their diseases,” Kraybill says. “Instead, they want to know what is going on, what are realistic expectations, where should they pursue cure and recovery, and where they need to accept what is. Primarily, they want someone who can honestly and respectfully look them in the eye and give them guidance on how to approach life and health.”

All Lancaster General Health family practice residents now shadow geriatricians in their second year of training so they can see how rewarding — and even fun — this field of medicine can be. The geriatrics practice currently has 16 geriatricians, an unusually high number for a community practice, he says.

That’s not enough to take care of every 80-year-old in Lancaster County, Kraybill says. Then again, not every 80-year-old needs a geriatric practice.

So who should see a geriatrician?

“It is less defined by age than it is by conditions and frailty,” Kraybill says. “We have some 85-year-olds who are spry and doing life and are not very complicated. And we have some 55-year-olds that are physiologically aged. ... Not everybody at 68 has to go see a geriatrician.”

Kraybill’s practice focuses on complicated, frail individuals who require more care and who often fall through the cracks at a standard medical practice. Rather than using age as a criterion, the practice has more of a screening protocol. They look at issues such as whether a patient is having more difficulty getting in a car or an elevator; whether dementia is setting in and complicating their ability to take medication, care for themselves and communicate; whether they have multiple medical issues or hospital stays.

“When all of that stuff starts piling up on each other ... it’s often appropriate,” he says. “When you’re at a point in life when you’re saying, ‘I love life. I don’t want to give up life. It’s getting so hard ... I’m looking to how I can transition to more comfort and palliative care.’ ”

Kraybill acknowledges that many who fall into that category may already have wonderful family physicians who treat older patients, and they should remain with that care. It all depends on the individual.

At the geriatrics practice, routine visits tend to last longer and include broader discussions about whether to continue or discontinue medications as well as advanced care planning.

As much as Kraybill tries to comfort his aging patients and guide them as they try to make the best life decisions, they have given him something in return. Throughout his career, he’s watched those ahead of him in life, he’s observed how they’ve handled the challenges of aging, and he’s learned.

“I think my plan is to fight hard at my health and try to prolong that and maintain that and do whatever I can to be independent and engaged and participatory,” he says. “My patients have taught me a lot about acceptance of what is. I have seen people deal with great suffering with great dignity. My goal at that point of life is to mirror them and walk gracefully through the end of life with as much connection with the people l love around me as possible.”