Utilizing Community Utilizing Community Resources for Medical Resources for Medical

EducationEducationJamehl L. Demons, MDJamehl L. Demons, MD

Aging ConferenceAging Conference

February 9, 2011February 9, 2011

Persons Over 50 Population Growth From 2000 to 2012 – Forsyth County

Data Source: 2000 (US Census) 2001 -2009 (Population Estimates) 2010 -2013 (Population Projections)

Percent of Population Over 50 with a Disability in Forsyth County

Community ResourcesCommunity Resources Senior ServicesSenior Services

Tab Williams Adult Day CenterTab Williams Adult Day Center Living-at-HomeLiving-at-Home Meals on WheelsMeals on Wheels

Area Agency on AgingArea Agency on Aging Family Caregiver Support GroupFamily Caregiver Support Group Ombudsman Program for nursing homesOmbudsman Program for nursing homes

Shepherd’s CenterShepherd’s Center Senior Financial CareSenior Financial Care Seniors’ Health Insurance Info ProgramSeniors’ Health Insurance Info Program

Older Adults as VolunteersOlder Adults as Volunteers

  

Source: Independent Sector, America’s Senior Volunteers, June 2000

Age 55-64Age 55-64 Age 65-74Age 65-74 Age 75+Age 75+

Percentage Percentage who who volunteervolunteer

50.3%50.3% 46.6%46.6% 43.0%43.0%

Tot. # Tot. # volunteersvolunteers

11.9 million  11.9 million   8.5 million  8.5 million   7.1 million 7.1 million 

Avg weekly Avg weekly hours per hours per volunteer   volunteer  

3.3 hours  3.3 hours   3.6 hours  3.6 hours   3.1 hours 3.1 hours 

Total time Total time volunteered volunteered annually   annually  

4.8 billion hrs 4.8 billion hrs   

1.6 billion hrs1.6 billion hrs 1.1 billion hrs1.1 billion hrs

Jamehl L. Demons, MD

SMILESMILESenior Mentor Independent Living Senior Mentor Independent Living

EducationEducation

Senior Services, Inc of Forsyth CountySenior Services, Inc of Forsyth County Nonprofit organizationNonprofit organization Meals on Wheels (MOW)Meals on Wheels (MOW)

Nearly 1000 seniors receive hot meals every weekday.Nearly 1000 seniors receive hot meals every weekday. Delivered by close to 1400 volunteersDelivered by close to 1400 volunteers Many volunteers over age 65Many volunteers over age 65

Community PartnershipCommunity Partnership

SMILE SMILE ((Senior Mentor Independent Living ExperienceSenior Mentor Independent Living Experience))

Unique opportunity for medical student Unique opportunity for medical student education outside the usual confines of education outside the usual confines of hospital and clinichospital and clinic

22ndnd year medical students make a single ride year medical students make a single ride (approx 1.5-2hours) on a MOW route and (approx 1.5-2hours) on a MOW route and interview the driver/volunteerinterview the driver/volunteer

Introduces the concept of successful agingIntroduces the concept of successful aging

Interview SkillsInterview Skills

Students collect more than a medical historyStudents collect more than a medical history Life historyLife history

Work historyWork history How successfully aged – deliverer & not recipientHow successfully aged – deliverer & not recipient Currently do to remain active Currently do to remain active

Interface w/ medical professionInterface w/ medical profession How things have changed in the last 50 years (home births, Dr. How things have changed in the last 50 years (home births, Dr.

housecalls, technology)housecalls, technology) Mentor’s experience with healthcare systemMentor’s experience with healthcare system

Accept instruction Accept instruction Mentor’s recommendations for new doctors.Mentor’s recommendations for new doctors.

CounselingCounseling

Important part of being physicianImportant part of being physician

AGE Page AGE Page Developed by the National Institute on AgingDeveloped by the National Institute on Aging Rotate topics: Falls, immunizations, depression, etc. Rotate topics: Falls, immunizations, depression, etc.

Effective communicationEffective communication Make it understandable to non medical personsMake it understandable to non medical persons

Mentor Recruitment & TrainingMentor Recruitment & Training

Utilize partnership talentsUtilize partnership talents

MOW volunteer coordinator selected namesMOW volunteer coordinator selected names Letter of invitation from coordinator and WFUSMLetter of invitation from coordinator and WFUSM Orientation luncheonOrientation luncheon

Description of programDescription of program Skit demonstrating good and bad performanceSkit demonstrating good and bad performance Review of Evaluation formReview of Evaluation form

Evaluation by Mentor: Assessment of Your Student

Student Name: ___________________________________________________ Date: ___________________________________________________________ My student arrived on time: _____ Yes _____ No My student Strongly

Agree Agree Neutral Disagree Strongly

Disagree Was eager to learn about aging

Was interested in me as a whole person

Was a good listener

Was interested in my thoughts

Effectively communicated tips for successful aging

Used language at an understandable level

What do you think are your student’s primary strengths? Do you have specific suggestions for your student that would have improved your interaction? If so, what are they?

EvaluationEvaluation PartsParts

Mentor feedbackMentor feedback Reflection Paper Reflection Paper

thoughtful analysis beyond facts thoughtful analysis beyond facts

Reviewed by a GeriatricianReviewed by a Geriatrician Completion is required Completion is required

Affects professionalism grade of geriatrics rotationAffects professionalism grade of geriatrics rotation

Reflection PaperReflection Paper

Describe the essential elements of your Describe the essential elements of your SMILE experience that are likely to influence SMILE experience that are likely to influence the way you practice medicine with your older the way you practice medicine with your older patients. patients.

(Minimum 1/2 page; Maximum 2 pages)(Minimum 1/2 page; Maximum 2 pages)

Student ReflectionsStudent Reflections

““The only advice he could provide for young The only advice he could provide for young doctors is continue to care.”doctors is continue to care.”

““It was interesting to hear him speak how It was interesting to hear him speak how healthcare had changed.”healthcare had changed.”

““He thinks that gaining your patients’ trust is He thinks that gaining your patients’ trust is the most important thing a doctor can do.”the most important thing a doctor can do.”

““He shared… the most important thing I can He shared… the most important thing I can do as a doctor is listen.”do as a doctor is listen.”

Student ReflectionsStudent Reflections

““I also observed that chronological age has little predictive I also observed that chronological age has little predictive value when it comes to health and vitality in the elderly.”value when it comes to health and vitality in the elderly.”

““I was truly humbled by the reality that older adults cannot I was truly humbled by the reality that older adults cannot be stereotyped; they are diverse.”be stereotyped; they are diverse.”

““She looked somewhat frail so I was surprised when she She looked somewhat frail so I was surprised when she swiftly grabbed the cooler…”swiftly grabbed the cooler…”

““An eye opening experience that reminded me of the An eye opening experience that reminded me of the importance of caring for people, not simply treating importance of caring for people, not simply treating patients.”patients.”

Student FeedbackStudent FeedbackIs one session sufficient?Is one session sufficient?

Perhaps a few more days in the schedule (such as Perhaps a few more days in the schedule (such as afternoons) with planned ridesafternoons) with planned rides

This may need to be required more than once in a year. I’m This may need to be required more than once in a year. I’m not completely sold on a single 3 hour experience being not completely sold on a single 3 hour experience being particularly revolutionary. It is a valuable experience but particularly revolutionary. It is a valuable experience but would gain even more power through reinforcement of the would gain even more power through reinforcement of the principles one is exposed to on the route.principles one is exposed to on the route.

I didn’t really have strong feelings about older adults to I didn’t really have strong feelings about older adults to begin with and the 2 hour ride-along didn’t do much to begin with and the 2 hour ride-along didn’t do much to affect my opinion one way or the other. I do have a better affect my opinion one way or the other. I do have a better opinion of volunteers and the Meals on Wheels program opinion of volunteers and the Meals on Wheels program though. though.

Student FeedbackStudent FeedbackUnderstanding the Purpose?Understanding the Purpose?

I felt like my driver was not really an elderly person. … same I felt like my driver was not really an elderly person. … same age as my parents, and maintains about the same functionality. age as my parents, and maintains about the same functionality. … more useful to observe elderly patients utilize the … more useful to observe elderly patients utilize the healthcare system, as we would see them in our future. healthcare system, as we would see them in our future.

I feel like I had very limited interactions with the MOW I feel like I had very limited interactions with the MOW recipients, and therefore did not have a significant amount of recipients, and therefore did not have a significant amount of time to change my attitudes. time to change my attitudes.

I think the mentor having to evaluate us made the meeting less I think the mentor having to evaluate us made the meeting less relaxed. I would understand if we were on the wards and we relaxed. I would understand if we were on the wards and we were having to treat a patient, but a spending a day talking were having to treat a patient, but a spending a day talking with someone should not. with someone should not.

Impact of SMILEImpact of SMILE

Introduces 2nd year medical students to the Introduces 2nd year medical students to the concept of successful agingconcept of successful aging

Novel means to provide health prevention Novel means to provide health prevention education to high functioning seniorseducation to high functioning seniors

Provides greater assessment of student in addition Provides greater assessment of student in addition to facultyto faculty

Medical Student CompetenciesMedical Student Competencies

Demonstrate effective physician-patient Demonstrate effective physician-patient interaction skillsinteraction skills

Effectively interact with patients from diverse Effectively interact with patients from diverse cultural backgrounds cultural backgrounds (seniors have a different (seniors have a different “culture” than 20somethings)“culture” than 20somethings)

Knowledge of healthcare delivery systemsKnowledge of healthcare delivery systems

What We’ve LearnedWhat We’ve Learned

SMILE definitely innovative program.SMILE definitely innovative program.

Bronze medal winning product in 2010 Bronze medal winning product in 2010 Reynolds Grantees Annual meetingReynolds Grantees Annual meeting

www.pogoe.orgwww.pogoe.org

Falls Prevention of Falls Prevention of Homebound EldersHomebound Elders

MorbidityMorbidityMorbidityMorbidity

30% of all community-dwelling persons over 30% of all community-dwelling persons over 65yo fall per year65yo fall per year

50% of all community-dwelling persons over 50% of all community-dwelling persons over 80yo fall per year80yo fall per year

1600 falls per 1000 nursing home patients per 1600 falls per 1000 nursing home patients per yearyear

40% of nursing home admissions are in part 40% of nursing home admissions are in part because of fallsbecause of falls

InjuryInjuryInjuryInjury

Fifth most common cause of death in the Fifth most common cause of death in the elderlyelderly

Falls cause 80% of all injuries of elderlyFalls cause 80% of all injuries of elderly 15% require medical attention15% require medical attention

40% of these require hospitalization40% of these require hospitalization average stay 8-15 daysaverage stay 8-15 days

InjuryInjuryInjuryInjury

1% incidence of hip fracture from falls= 1% incidence of hip fracture from falls= 250,000 per year250,000 per year

25% of persons >80yo with hip fracture will 25% of persons >80yo with hip fracture will die in the next year compared to 15% in the die in the next year compared to 15% in the general population over 80general population over 80

An objective of the US Public Health An objective of the US Public Health Service is to reduce hip fractures in the over Service is to reduce hip fractures in the over 65 population from 714/100K to 65 population from 714/100K to <600/100K by the year 2000<600/100K by the year 2000

Financial CostFinancial CostFinancial CostFinancial Cost

Individual hospitalization for fall-related Individual hospitalization for fall-related injury ~$6500injury ~$6500

Annual cost $12,600,000,000Annual cost $12,600,000,000 ?Subsequent long term costs?Subsequent long term costs

nursing carenursing care nursing home admissionnursing home admission physical therapyphysical therapy

Psychological CostsPsychological CostsPsychological CostsPsychological Costs

50% develop fear of falling50% develop fear of falling 25% restrict activity to avoid further falls25% restrict activity to avoid further falls Decreased independenceDecreased independence Fear of falling develops in 20-45% of Fear of falling develops in 20-45% of

nonfallersnonfallers

Senior Services of Forsyth CountySenior Services of Forsyth County Nonprofit organization with many sections to help aging Nonprofit organization with many sections to help aging

populationpopulation Meals on WheelsMeals on Wheels

Paid staff assesses appropriateness for program semi-annuallyPaid staff assesses appropriateness for program semi-annually

Utilizing Existing ProgramsUtilizing Existing Programs

Meals on Wheels AssessmentMeals on Wheels Assessment Falls related questions addedFalls related questions added Have you fallen in the last 6monthsHave you fallen in the last 6months Are you afraid of fallingAre you afraid of falling

Anyone answers yes offered falls programAnyone answers yes offered falls program

Falls Assessment ClinicFalls Assessment Clinic

FreeFree One-time, in-home, comprehensive falls risk One-time, in-home, comprehensive falls risk

assessmentassessment IncludesIncludes

Medical History and physical examMedical History and physical exam Tinetti Performance Oriented Mobility Assessment Tinetti Performance Oriented Mobility Assessment

(POMA)(POMA) Home environment assessmentHome environment assessment

Education ComponentEducation Component

Internal medicine and Family medicine Internal medicine and Family medicine residentsresidents Read the assessmentRead the assessment Read AGS White paper on Falls PreventionRead AGS White paper on Falls Prevention Perform the assessmentPerform the assessment Review recommendations supervised by Brooke Review recommendations supervised by Brooke

DavisDavis

Falls assessments Falls assessments 33rdrd year medical students during Geriatrics year medical students during Geriatrics

Single visit with the MOW assessorSingle visit with the MOW assessor Ask the falls-related questionsAsk the falls-related questions Mediation reviewMediation review Get up and GoGet up and Go Mini-cogMini-cog Brief home assessmentBrief home assessment

Findings reviewed with faculty at the end of Findings reviewed with faculty at the end of the rotationthe rotation

What We’ve LearnedWhat We’ve Learned

Close collaboration with community partnerClose collaboration with community partner Assist recruiting drivers/volunteersAssist recruiting drivers/volunteers Match students with driversMatch students with drivers Assessor interaction with studentsAssessor interaction with students

Know your studentKnow your student SMILE Better in 2SMILE Better in 2ndnd year curriculum than 3 year curriculum than 3rdrd

Focus on interviewing skillsFocus on interviewing skills 33rdrd year want to focus on more clinical activities year want to focus on more clinical activities

What We Don’t Know… yetWhat We Don’t Know… yet

Does early interaction with healthy, active Does early interaction with healthy, active seniors increase interest in Geriatrics as a seniors increase interest in Geriatrics as a career? career?

Is one visit enough to make a difference in Is one visit enough to make a difference in history of ageism at the time of patient history of ageism at the time of patient interactions?interactions?

Supported by funding from the Donald W. Supported by funding from the Donald W. Reynolds foundationReynolds foundation

Jeff Williamson, MD, MHS PIJeff Williamson, MD, MHS PI

Hal H. Atkinson, MD, MS Co-PIHal H. Atkinson, MD, MS Co-PI

Jan Lawlor, Project coordinator SMILEJan Lawlor, Project coordinator SMILE

Brooke Davis, Project coordinator Falls ClinicBrooke Davis, Project coordinator Falls Clinic