sanguinemare

August 10, 2011

Geriatrics and the Senior Mentor sessions

Filed under: Med School and the MSTP — sanguinemare @ 4:54 pm
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My apologies for being rather AWOL – things are starting to pick up, and I’ve had to take care of some other things, such as house-hunting.  (I figure, since we’re going to be here 8 years, might as well buy a house so the money you spend on mortgage, etc will actually come back to you when you go to sell it, instead of going down the drain through renting the next 8 years.  2 of us my year have already bought houses, and so have many of the other, older MSTP’s.  Something to think about when/if you plan on going into one of these programs.  Of course, it also depends on where you’re living… places like NY or CA, for example, are not going to be the best place to plan on buying your own home, unless you’re extremely well off.)  House-hunting has been a pretty big/tiring thing to deal with – more on that later.  We also have our first test tomorrow for this Patient, Doctor, and Society course module we’ve been on the last 3 weeks.  And here I am, procrastinating by posting, just like in good old undergrad days.  Ah well.

Just a side note:   I have been making an effort to keep things in chronological order, but I’m so backlogged with nebulous, half-written posts that if/when I ever get a chance to finish them, they will likely be posted way out of order or spaced very oddly along the current timeline.  Or, they will very simply never see the light of day. I am very sorry for this, and can only promise to do better in the future, but with no guarantees.  “Real” med school starts next week, and my family is coming in this weekend for our White Coat Ceremony and to help with house-hunting, so I may well be gone from here for another week.  Eep!

ANYWAY, onto our topic of the day: Geriatrics!  A field rarely considered when one first starts medical school, but one with ever-increasing needs as greater numbers of people live longer and longer.  According to the lecture, most of the U.S. states have 10-15% of their population 65 years and older in the year 2000, with projections of the average state having 20-25% of their population 65 years and up in the year 2025.  That’s a quarter of the population!  Crazy.  Statistics show that the greatest increases of people growing older over the last few years are for those 85 years and up.  But even more recently, the fastest group are the centenarians (people 100+ years old)!  And how many doctors are there to serve this growing population?  Only 7700 geriatricians across the U.S., according to the lecture.  I just looked up the numbers to double-check online, and the American Geriatric Society (AGS) (http://www.healthinaging.org/public_education/what_is_geriatrics.php) says there’s about 9000, plus a few osteopathic geriatricians, and 2,400 board-certified gerophysiciatrists.  That’s a pretty small number compared to say, 661,400 practicing physicians/surgeons in 2008.

Getting a little away from statistics, the professors brought up the point that the older we get, the more heterogeneous we get.  In other words, the older population has people ranging from the bed-bound senior who can barely control their own bodily functions, to the athlete training for the Senior Olympics.  They emphasized that aging is not a diagnosis and not a disease.  Rather that many diseases are associated with aging, such as cataracts, cancer, diabetes, but there are also very healthy seniors who only come in once a year for their annual check-up.  That was a good point for me to think about, because as someone who’s never really known her grandparents (they all passed away before I was born or when I was very young), I usually associate the image of an “old person” with someone who is frail, sickly, and needs help with many day-to-day activities.   Perhaps many others also had this view, which is why our school has set up a “Senior mentor” who we are supposed to pair with throughout the next two years in medical school before the clinical years.  We are to meet with them semi-regularly, and the goal is partly to help us practice our skills in interviewing/talking with the patient and to learn about the challenges they might face, but also to help us realize that being old doesn’t necessarily mean not being healthy.  They want us to see that people are still highly active and functional at their age.  And hopefully of course, we can give back to them as well through our interactions with them, whatever form that might take.

The other cool thing they did today was the SECURE Adult Sensitivity Activity we did in class today.  I assume this is something they do at other campuses too, because there was a whole videotape and kit and everything.  So if you’re planning on going to med school, you may want to skip the rest so you can experience it yourself the first time without knowing anything.  But if you’re curious, feel free to read on (I’ll tell you what all the stuff was supposed to simulate at the end, so you can also read through until the last bit to keep some of the suspense). So inside the kit, they had:

  • 5 pairs of paper glasses – some with cut-outs, others with different “lenses”
  • a pair of large, cloth gloves that felt kind of rubbery on the outside
  • an mini sewing kit – the complimentary kind some hotels give
  • a medicine bottle with circular sprinkles you find on cupcakes  inside it
  • a paper with numbers and letters scattered across it from 1-13 and A-H or so

We were first told to try on the 3 pairs of glasses with different cut-outs.  The first had just two holes in the center of the glasses, so you could only see the very middle of your vision range.  The 2nd had a U-shape cut out that spanned the bottom edge of the lens, so you could only see the bottom and a little of the sides of your vision.  The last had the left half of each lens cut out, so effectively, you could only use your right eye to see, and only half the vision range.  Want to take a guess what the 3 glasses were supposed to simulate?

Next, we were told to put the 4th pair of glasses on and take out a pen and the piece of paper.  We were supposed to try to connect the numbers, starting from 1 and ending at 13.  It was really tough though, because the numbers were scattered all over and with the alphabet letters scattered in between, and the lens was so distorted/fuzzy that you could not see anything.  I literally put the paper about 2 inches from my nose and still could not really make out the shapes.  Guess what what one was.

Finally, we took the last pair and were told to take the medicine bottle out.  We shook out the colored pellets and were supposed to find 1 white one, 2 green ones, and 3 blue ones.  The lens was clear, yellow plastic, and it made it really difficult to see certain colors, especially green and blue.  Apparently this “yellowing of the lens,” pretty common among people with light-colored eyes as they turn ~50, may be a contributing factor to why some people wear really strangely mismatched clothing.  So don’t judge too quickly when you see people like that – perhaps it’s a vision problem, not a mental problem.

Next, they talked about hearing loss, and played samples of each.  Apparently the normal range is between -10 to 26 dB.  Mild hearing loss is between 27-40 dB.  At this stage, people will not usually notice it, and will deny having any hearing problems.  Moderate hearing loss is at 41-55 dB, and it really was hard to hear, especially the woman’s voice.  At this time, the problem will be noticed both by people around the person (they will need to repeat themselves, talk louder, etc), and by the person themselves.  Male voices are easier to hear because they are in a lower range, and

Lastly, we put on the glove, donned a pair of the aforementioned glasses, and set to work trying to thread a needle. Or button two buttons together.  Or grab something small out of a purse.  I pretty much decided the first was going to be more work than it was worth, so set about trying to put the buttons together.  It was surprisingly, much more difficult than expected, mainly because I was trying really hard not to drop the two buttons, because I knew it was going to be a pain trying to pick them back up with those unwieldy gloves.

So, what were the age-associated problems these were trying to mimic?*SPOILER*

  • Glasses 1: Glaucoma, which gives one “tunnel vision” – due to increased pressure in the blood vessels of the eye
  • Glasses 2: Macular degeneration – giving the opposite effect of tunnel vision, where you have the middle of the vision cut out due to a kind of blockage in the retina.
  • Glasses 3: Blind on one side due to stroke
  • Glasses 4: Cataract – the most common eye disease for older people, and a major cause of blindness
  • Glasses 5: Yellowing of the lens
  • Gloves: Arthritis

*END SPOILER*

They also went into a little bit about mental illness and dementia, mostly caused by illness or medication/alcohol toxicity.  One interesting thing patients might do is to put all their different medications in a bowl, then pick out the total number they are supposed to eat for the day/meal.  This can obviously create problems with them potentially eating multiple doses of one medicine and not eating any of another.

All in all, an interesting exercise and good food for thought.

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