Dr. Matthew Weiss’ “patient,” an older man playing the role of an 80-year-old with diabetes, told Weiss he recently fell on the way to the bathroom and hit a dresser.
“I toppled over and banged my head into it on the way down,” the man said.
Weiss suggested the man sit on his bed at first when getting up, to steady his blood pressure. He checked the man’s feet and asked about medications and throw rugs. When the man said he drinks two beers every night, and sometimes more, Weiss cautioned that alcohol can increase the risk of falls.
Dr. Steven Barczi, a UW Health geriatrician who oversaw the training session for Weiss, a first-year resident, praised Weiss’ performance, including his gentle nudge about drinking. But Barczi said Weiss should have asked about the man’s glasses, as outdated prescriptions can also trigger falls.
“Don’t forget about vision,” he said.
The session — involving Richard Russell, 74, of Madison, who works as a mock patient to help young doctors learn — is part of a growing effort at UW-Madison and around the state to better prepare health care providers to serve an aging population.
Wisconsin’s share of people 65 and older, estimated at 895,000 in 2015, is expected to grow to 1.5 million by 2040. That’s a 72 percent increase, compared to anticipated growth among all ages of just 12 percent.
A state report this year projects a shortage of 745 primary doctors by 2035. Last year, a national report predicted a shortage of 27,000 geriatricians — doctors who specialize in treating the elderly — by 2025, including 3,430 in the Midwest.
Given the forecasts, it has become clear that all doctors, nurses, pharmacists and other providers need at least some geriatrics training, said Barczi, UW’s clinical director of geriatrics.
“There’s never going to be enough geriatricians to care for the large cohort of older Americans,” he said. “We need to be more intentional about making sure everybody has had some basic exposure to the nuanced care of older persons.”
That’s the goal of recent initiatives at the UW School of Medicine and Public Health, Madison’s Veterans Hospital and a group led by Marquette University that shares a federal geriatrics workforce grant.
Older adults “have complex health needs that not all providers are equipped to deal with,” said Stacy Barnes, a nursing professor at Marquette who heads up the federal grant project. It recently started training paramedics to recognize signs of dementia and ways to calm patients who have it.
Talking with older patients
UW started requiring medical students to take a two-week unit on geriatrics this year. A monthlong geriatrics rotation for internal medicine residents, long available as an elective, became mandatory about five years ago, Barczi said.
In addition to instructing students and residents about falls, dementia, depression and other topics that especially affect the elderly, the programs emphasize communication with older adults, he said.
Doctors should talk with elderly patients first, even if they have dementia, when caregivers are also present during clinic visits, Barczi said. With older patients, doctors might need to speak louder and slower, and emphasize a few key issues instead of mentioning every point.
“You’re not going to be able to get through 10 items in 25 minutes,” he said.
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At the Madison VA, nurses, pharmacists, social workers, psychologists and speech pathologists can get certifications in geriatrics. A geriatrics scholars program, which is also available at some other VAs around the country, provides intensive training to a dozen providers a year, and involves workshops for others at rural clinics.
Dr. Paul Mannino, a family medicine doctor at the VA clinic in Rockford, Illinois, spent a week in geriatrics clinics in Madison last year through the geriatrics scholars program. Through the program, he enrolled some of his Rockford patients in telehealth monitoring to try to keep them out of the hospital.
Now, “I have less fear in managing complex geriatrics patients,” Mannino said.
Geriatrics workforce grant
UW and Marquette, along with the Medical College of Wisconsin, Aurora Health Care and the Alzheimer’s Association, are partners in a $3.4 million, four-year federal Geriatric Workforce Enhancement Program grant, which runs through next year.
Through the grant — one of 44 nationally — the Medical College developed online courses about medication interactions and advanced directives, which providers can take to meet continuing education requirements.
Sixteen nurses at two Aurora hospitals got intensive training in working with older adults, Barnes said.
Reference guides for treating insomnia, interpreting heart monitor changes, diagnosing osteoporosis and other topics have been available for providers at geriatricfastfacts.com.
The Alzheimer’s Association’s Southeastern Wisconsin chapter trained first responders from Milwaukee city and county, UW-Milwaukee and the North Shore Fire Department on how to recognize aggression and other challenging behaviors as signs of dementia.
Such training, designed to prevent people with dementia from unnecessarily entering the criminal justice system, could expand to other parts of the state if the coalition gets another federal grant after next year, Barnes said.
At UW, Weiss’ recent training session under Barczi’s guidance was also supported by the grant. UW and the VA are designing a virtual version that could make such training more available in rural areas, Barczi said.
In another in-person training session last month, Dr. Emily Owen, also a first-year internal medicine resident, assessed an 87-year-old patient — played by John Smith, 82, of Madison — for dementia.
He said he had left his stove on several times and forgot to pay some bills, causing him to move in with his son and daughter-in-law. Owen asked a range of questions and said she’d connect the family with a social worker.
Dr. Sanjay Asthana, head of geriatrics at UW and director of the university’s Wisconsin Alzheimer’s Disease Research Center, complimented her evaluation.
But he said it’s important to determine if memory impairment is short or long. One way is to ask if patients are taking sleeping pills, like Tylenol PM, which can cause temporary cognitive lapses, he said.
“Always remember medications,” Asthana said.
This article was supported by a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and the John A. Hartford Foundation.