On a picnic blanket at Piestewa Peak in Phoenix, AZ, Rowena passed around orange honey almonds while Barbara read an Elizabeth Chase Allen poem to us. My friend Dosia pointed out the growing audience of curious squirrels hoping we would drop a few treats. The conversation turned to favorite springtime memories; our laughter cut through the quiet of the desert. Nadine brought out a layered chocolate cake for her boyfriend – today was his birthday. He was turning 80. In fact, everyone at the picnic eclipsed me in age by about five decades, though that was no matter. Today, we were just friends enjoying a picnic.
Dosia and I met through the University of Arizona College of Medicine’s Senior Mentor Program (SMP), which pairs medical students with older adults from the community. Through the program, students build long-term, meaningful relationships with seniors – a patient population that the medical community often deems complicated, time-consuming or irritable. In addition to dispelling myths about seniors, the program aims to increase interest in geriatric care. More than two-dozen medical schools across the U.S. have some form of a Senior Mentor Program.
My own senior mentor is quite impressive. Wheelchair-bound since youth after battling polio, she has three PhDs (in psychology, higher education, and religious education) and is an ordained minister, an adjunct professor, author of several books, and one of the founding members of Hospice of the Valley. She is a skilled piano player, despite limited use of her left arm – also a result of polio.
In our time together, Dosia and I have baked sugar-free cookies, attended a wind instrument concert, gone on nature walks, and enjoyed many meals together. In addition to just socializing with older adults, students and their mentors attend mutually beneficial SMP lectures on topics such as pain management, hypertension, foot care, nutritional supplements, and fall prevention. Students are also encouraged to accompany their senior mentor to a doctor’s appointment.
Studies have shown that SMPs positively change students’ attitudes toward older adults and increase their knowledge about geriatric patient care. It remains to be seen, however, if programs like this actually encourage medical students to enter primary care.
The majority of elderly patients are not seen by geriatricians; they are mostly under the care of family physicians and internists. Seniors constitute 12 percent of the general population, but make up almost 50 percent of a primary care physician’s patients, according to the Alliance for Aging Research. Therefore, at a minimum, primary care physicians should be comfortable managing multi-system chronic conditions with an understanding of the aging process.
Unfortunately, in medical education, geriatrics has become synonymous with a narrowed focus on dementia, incontinence and polypharmacy. We rarely discuss preventive medicine in older adults or tools like the Comprehensive Geriatric Assessment, which has shown to lower patient mortality and extend time living at home. Also overlooked are the vibrant populations within the geriatric community: LGBT seniors, those with developmental disabilities, refugees, veterans, and marathon runners, to name a few. These oversights contribute to a simplified view of elder care.
The decision to enter primary care is multifarious, but is ultimately rooted in the love of connecting with people. It takes inspiration from many mentors, including physicians, colleagues, and most importantly, patients. Dosia showed me that people could never be reduced to an age and diagnosis. She has given meaning to the term “healthy aging” and shaped the way I will interact with patients in the future.
Natasha Bhuyan is a family medicine resident who blogs at Primary Care Progress.
