Tuesday, December 15, 2009

Seniors Teach Med Students Finer Points Of Elder Care

UAB Reporter

Lorain Devito is an expert on the elderly. She knows their tendencies, their likes and their dislikes. She knows how strong their will can be. She also knows their fears.

Devito knows these things because she, too, is elderly. Devito is a resident at Episcopal Place, a Section 202 supportive-housing program that provides seniors and disabled adults with restricted income safe and affordable housing and access to related services in a home-like environment.

She’s a very busy lady. Devito, a diabetic, swims regularly and helps interview potential Episcopal Place residents. She also volunteers for two programs in the School of Medicine — the Senior Mentor Program and the History of Medicine Program — and she meets with medical students to discuss health care.

“I look at this as an opportunity to give back and an opportunity to help the physicians of tomorrow better understand geriatrics,” Devito says.

Both programs have been a part of the School of Medicine and the Division of Gerontology, Geriatrics and Palliative Care for several years and recently received a jolt with a $2 million grant from the Donald W. Reynolds Foundation and a $1 million match from the university. Christine Ritchie, M.D., director of palliative and supportive care, is the principal investigator for the four-year grant, which will improve education for the school’s 875 medical students and for 350 residents, numerous faculty and community physicians.

“Both programs were part of the original grant proposal and are receiving much-needed funding,” says Angela Rothrock, Ph.D., assistant professor in gerontology, geriatrics and palliative care and associate director for the day-to-day operations of the UAB Reynolds Program. “The grant will enable us to change the programs — particularly the Senior Mentor Program — in positive ways. It’s certainly reinvigorated the programs and helped us increase the diversity of our seniors.”

Stan Massie, M.D., associate professor of general internal medicine, oversees the Senior Mentor Program for first-year medical students. Richard Sims, M.D., professor of geriatrics, is the co-director.

Rothrock says Massie and Sims were responsible for starting the program and have kept it going with little funding.

The course is a unique opportunity for first- and second-year medical students to be paired with a senior citizen living in the Greater Birmingham area.

Among the goals of the program:
• Provide students with an opportunity to develop a working relationship with a patient
• Expose students to community-dwelling elders
• Enable students to visit elders outside of UAB
• Provide opportunities for students to practice their interviewing skills
• Make students aware of some of the principles and challenges involved in care of the elderly

Two students are paired with an adult and visit their senior mentors approximately six to seven times in two years.

“There are specific things we want them to learn each visit,” Rothrock says. “One visit might be learning to do history-taking. One might be learning to do a cognitive assessment, a depression scale or a medication review. There are specific clinical skills we want them to learn. But we also want them to learn that all older adults are not sick and frail. There are older, healthy and vibrant adults in our community who they have a lot to learn from.”

Focus on geriatrics

The Donald Reynolds Foundation grant is part of $80 million it gave to UAB and 39 other medical schools to focus student learning on better care for the elderly.

The grant requires internal medicine residents to spend one month in geriatrics training in settings that include acute care for the elderly, a long-term care facility, outpatient clinics and home-care visits. Other programs, including interactive, online training modules and special geriatric training for residents in internal, emergency, family and pediatric medicine, also are in development.

The Senior Mentor Program also will evolve into an interdisciplinary program.

“It won’t just be a medical student working with an older adult, it will also be a nurse, a social worker, a dental and a therapy-based-practice student working in teams,” Rothrock says. “The professionals in training will discuss how to work in an interdisciplinary team to best care for older adults.”

Training in geriatrics, the area of medicine that focuses on diagnosing and treating diseases and problems particular to older adults, is essential for future physicians.

The first Baby Boomers begin turning 65 in 2011, which creates an additional sense of urgency. The Silver Tsunami, or wave of seniors seeking medical care, is expected to increase dramatically during the next decade.

“Given the changing demographics, we’d have to train far more physicians than we are able in order to have enough geriatricians,” Rothrock says. “So even if you’re not a geriatric specialist, you’re going to have to care for older adults. What we can create are geriatric-friendly physicians so that any physician coming out of training is attuned to geriatric needs and able to recognize that caring for older adults requires a different perspective on health care.

“If we don’t train health-care professionals in general to care for older adults, from basic communication skills to very technical clinical skills, they’re not likely to learn it,” Rothrock says. “In the average medical journal you’re learning about outcomes in a 40-year-old white man, and that’s not who’s going to be coming into their clinics.”

Mentors are the teacher

That’s why the mentorship program is so valuable to students. They get an opportunity to begin learning the way seniors live and think.

In fact, Rothrock makes it known when she is recruiting the seniors that they are to make sure they do one specific thing with the students — speak their mind.

“I tell these local residents, ‘You’re the teacher. If you don’t like the way they ask you questions, tell them,” Rothrock says. “This is a collaborative model. The seniors aren’t just guinea pigs. It empowers them and gives them some ownership in the program.”

Devito is more than happy to do that after 14 years without taking charge of her own health. Part of that blame she says is hers, but she also says her physician never pushed her hard for information and never fully educated her on potential outcomes due to her medical issues.

“You go to a doctor because you want answers and direction — at least that’s why you should go,” Devito says. “Geriatrics are not always honest about their health. They think, ‘If I have this problem or that problem and tell the doctor about it, I’m going to wind up in the hospital having surgery.’ Obviously that’s not always the case. I think this program will better prepare these students to treat geriatrics. Because I can assure you, they are going to see patients just like me, who gave very little information and thought they could handle their health on their own. I’m glad I’ve got a doctor now that will ask me questions and tell me what to do.”

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