{"id":5569,"date":"2019-06-05T08:42:06","date_gmt":"2019-06-05T12:42:06","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=5569"},"modified":"2019-06-05T08:42:06","modified_gmt":"2019-06-05T12:42:06","slug":"the-senior-mentor-home-visit-program-the-story-behind-the-grant","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2019\/06\/the-senior-mentor-home-visit-program-the-story-behind-the-grant\/","title":{"rendered":"The Senior Mentor Home Visit Program: The Story behind the Grant"},"content":{"rendered":"

Maggie, 82, sits on a metal chair across from her new family doctor.<\/span><\/p>\n

\u201cI\u2019ve just been feeling tired lately,\u201d she tells the young MD.<\/span><\/p>\n

\u201cWell, no wonder!\u201d the doc responds. \u201cYou\u2019re 82!\u201d<\/span><\/p>\n

Actually, Maggie\u2014who does tai chi, volunteers at an animal shelter and is sporting a sea glass necklace from her latest beach vacation\u2014has developed a persistent bout of depression. But her newly minted doctor, who has mostly only ever seen older people in the hospital, thinks she\u2019s doing great, \u201cconsidering.\u201d<\/span><\/p>\n

This hypothetical situation is the kind that medical schools have been working to prevent. If med students only see older people in the hospital with pneumonia and broken hips, they can get a skewed impression of what their lives are like.<\/span><\/p>\n

So in 2011, the Silver Century Foundation stepped in to help combat this challenge, funding the Senior Mentor\/Home Visit Program at the Robert Wood Johnson Medical School in New Brunswick, NJ. <\/span><\/p>\n

By the end of two grant cycles, 48 medical students had learned, as one put it, \u201cnever, ever, ever judge a book by its cover.\u201d And the medical school had a solid foundation for what would become an ongoing mentor program.<\/span><\/p>\n

Ageism Prophylactics<\/b><\/p>\n

In 2011, Kay Klotzburger, founder and president of the Silver Century Foundation, was looking to fund a promising ageism-prevention project. She just hadn\u2019t found it yet.<\/span><\/p>\n

Until that point, the foundation had mostly funded programs that served older adults. But Klotzburger was frustrated; she kept encountering hardwired ageism\u2014in both older and younger people. She wanted to pivot to prevention, to stop ageism before it began.<\/span><\/p>\n

Grace Egan, whom she\u2019d worked with on the <\/span>New Jersey Elder Index grant<\/span><\/a>, told her about a project that might fit the bill. The Robert Wood Johnson Medical School (now a part of Rutgers University) was looking to launch something called a senior-mentors program. The purpose was, in large part, to combat ageism in medicine.<\/span><\/p>\n

\u201cAs students go through medical school\u2014particularly as they get to the clinical years\u2014they\u2019re actually spending most of their clinical time in a hospital setting,\u201d explains Joyce Afran, MD, co-director of Patient Centered Medicine at the medical school. \u201cSo they really don\u2019t have the opportunity to develop an understanding of what\u2019s actually happening when patients leave the hospital\u2014how they\u2019re managing their chronic medical problems at home, how well they\u2019re functioning.\u201d<\/span><\/p>\n

This can lead to a tendency to dismiss treatable medical problems as just part of old age. \u201cThey\u2019re seeing patients when they have problems and they\u2019re in a gown and they\u2019re not really moving,\u201d says Afran. \u201cYou [as a student] don\u2019t see what they can do\u2014to understand what you can get them back to.\u201d <\/span><\/p>\n

Doctors in every specialty need to know more about aging. For example, orthopedic surgeons\u2014who see patients at their physical worst\u2014need to understand that people of all ages have lives to get back to (and to do intensive physical therapy for).<\/b><\/p><\/blockquote>\n

So, in the early 2000s, medical schools were testing out solutions. One promising option was the senior-mentors model.  <\/span><\/p>\n

In senior-mentors programs, healthy older people living independently in the community served as \u201cmentors\u201d to medical students. The students visited their homes and practiced essential skills, such as taking medical histories and checking for fall hazards. Over the course of a few visits, the students also got to know these older people as human beings.<\/span><\/p>\n

The Robert Wood Johnson Medical School had tried such a program a few years before but needed a grant to start one up again. So the Silver Century Foundation provided it.<\/span><\/p>\n

The new program\u2014which Afran helped run, along with Fred Kobylarz, MD\u2014launched in 2011 with 18 medical students. The following school year, enrollees jumped to 30.<\/span><\/p>\n

One student wrote in a course evaluation after the first year, \u201cWe learned that some people can maintain their good physical and mental health long into their \u2018old age\u2019 so be sure to understand how well your Senior patient is able to function and treat them like adults & not needy incapable children\u2014as our mentor told us.\u201d<\/span><\/p>\n

Prevention Prescription<\/b><\/p>\n

The Senior Mentor Home Visit Program was an elective track for second-year medical students in the Patient Centered Medicine course. Students don\u2019t choose their specialty until the third or fourth year, but \u201cI don\u2019t care what specialty you\u2019re going to go into, you will encounter older adults,\u201d points out Kobylarz, director of the school\u2019s Center for Healthy Aging. \u201cSo even if you\u2019re a pediatrician, Grandma might be bringing in little Johnny for whatever, and you better be able to think about what Grandma might be saying.\u201d<\/span><\/p>\n

\u201cI think especially the students who are not going into primary care\u2014we hope that they\u2019re the ones who are taking with them a better understanding of what it\u2019s like to be an older adult and be functional,\u201d says Afran. For example, orthopedic surgeons\u2014who see patients at their physical worst\u2014need to know that people of all ages have lives to get back to (and to do intensive physical therapy for).<\/span><\/p>\n

In the school\u2019s mentor program, the students visited their mentors three times. Each visit had a specific focus. The first covered functional abilities, the second, medication management and the third, home environment. Students were given lists of topics to ask their mentors about. Being only second years, they were barred from giving medical advice.<\/span><\/p>\n

Over the course of the three visits, students learned details about such personal but medically relevant topics as:<\/span><\/p>\n