Dr. Emily Hilderman is a UW School of Nursing DNP alumni and previously worked as a graduate staff associate at the de Tornyay Center. Dr. Hilderman is a primary care nurse practitioner at UW Medicine and Era Living retirement communities. A clinical preceptor, she works with nurse practitioner students from the adult geriatric program as part of her work in the UW Medicine clinic.
Why did you choose nursing?
After finishing my BA, I was working in an adult day health center as a case manager and program coordinator when I realized I wanted more tools to be able to change people’s quality of life. I saw patients and family caregivers struggling to connect with health services, and nursing allowed me to be that bridge.
What interested you about healthy aging and working with older adults?
I’ve always had an affinity for older adults in my family and my community. I love collecting stories, learning about their history and goals for their future.
Could you tell me a little bit about your current work as a practitioner?
My current practice is with UW Medicine. I split time between the primary care clinic at Northgate and one NP clinic at Aljoya Thornton Place. The Aljoya clinic is a partnership between UW Medicine and Era Living to provide on-site services for people that live or work in the building. As part of that partnership, I provide support for best practices in memory care for each of the Era Living retirement communities. This gives me a great balance between direct clinical care and practice inquiry/research.
Is the job similar between the two sites?
Very different. At our Northgate clinic, we have an amazing interdisciplinary team of family medicine providers, which sees over 200 people daily. In comparison, Aljoya feels like a small town since I get to know most of the people living or working in the building. Since I am on-site and available for drop-in visits at Aljoya, it’s easy for residents to come in to clinic and say, ‘my blood pressure was off this morning, can we check it?’ versus waiting a month to get a visit with me for follow up at the Northgate clinic.
Then you’re working on a project to help primary care providers better assess dementia, is that right?
I always love an opportunity to work with research and, in particular, how we connect research with daily practice and patients’ lives. Recently I have participated in a couple different research projects focusing on dementia care. One is looking at diagnosing dementia in primary care, another looking at starting conversations about health directives for people with dementia, and the last is looking at the efficacy of using technology to connect older adults with evidence-based exercise programs.
I know you’re also a clinical preceptor. Why did you decide to start precepting?
I think it’s important to do. It helps push my practice because students ask a lot of good questions and challenge you to be the best provider you can. I remember how much of a difference it made to have diverse and interesting clinical rotations. It shapes who you become as a provider. Many rotations were limited because of COVID so I prioritized hosting a student each quarter.
What do you think is one of the current most important issues in older adult health care?
One of the most important things that I’ve seen recently is how do we help people keep connected in a time of technology, when there’s infection prevention realities that have to be recognized. Coming out of COVID we’ve learned a lot about how devastating social isolation is for our older adults.
What strategies are there for addressing it?
I think talking about it, asking people what their community connections are, helping them prioritize things that bring them joy. We are lucky in Seattle to have a number of community resources from transportation or other programs to help connect patients to a day program, an exercise group, or a spiritual center. That side of people’s health should be something we support as a primary care provider as well as ‘what’s your blood pressure reading’, ‘how are you doing on taking your medication on time’, etc.
Since graduating, what do you think is the most important thing that you’ve learned?
The biggest thing I’ve learned is to trust the team and to listen to what people are telling you, whether that’s the patient, as the center of the team, but also their family or their caregivers. If they’re saying that something has changed, how do you take that data and work with it? Also, to build a strong interdisciplinary team, because you can’t do it all yourself.
What’s the most surprising thing that you’ve learned?
When I started in primary care, I was most surprised by how much mental health we manage. Primary care really is the gateway for people to access mental health care, whether that’s medications or just support as far as having a horrible six months, and of course connections to counseling and psychiatry. I’d say of the patients I see in a day, 50% of them are explicitly for mental health, either coming in for anxiety or depression or for physical symptoms that are related to it. Everything from sleep problems to headaches or chronic pain can be mental health affecting physical health. Primary care manages medication for conditions from anxiety and depression to schizophrenia, bipolar, or dementia-related behavior changes. We’re often the first call when somebody can’t connect. We’re that first line to try to get someone stabilized and then bring in more resources. And the degree it’s needed continues to surprise me.
Is there anything else you want to share?
I love working with older adults and their care teams, whether that’s family, assisted living, or whoever is involved. There are so many unique opportunities to help people maximize their health throughout their years.