"Patient" from Dr. Matthew Weiss, an older man playing the role of an 80-year-old man with diabetes, told Weiss that he recently fell on the way to the bathroom and knocked on a dresser.
"I fell over and hit my head on the descent," the man said.
Weiss suggested that the man should sit in his bed at first, when he got up, to stabilize his blood pressure. He checked the man's feet and asked about medications and threw rugs. When the man said he drank two beers every night, and sometimes more, Weiss warned that alcohol could increase the risk of falls.
Dr. Steven Barczi, a UW Health geriatrician who oversaw the Weiss training session, a first-year resident, praised Weiss's performance, including his gentle push toward drinking. But Barczi said Weiss should have asked about the man's glasses, as outdated prescriptions can also trigger falls.
"Do not forget the vision," he said.
The session – involving Richard Russell, 74, of Madison, who works as a simulated patient to help young doctors learn – is part of a growing UW-Madison and state effort to better prepare health professionals to serve an aging population .
The share of people 65 years of age or older from Wisconsin, estimated at 895,000 by 2015, is expected to grow to 1.5 million by 2040. This represents a 72% increase compared to the predicted growth for all ages of only 12%.
A state report this year projects a shortage of 745 primary care doctors by 2035. A national report last year predicted a shortage of 27,000 geriatricians – doctors specializing in treating the elderly – by 2025, including 3,430 in the Midwest.
Given the predictions, it became clear that all doctors, nurses, pharmacists and other providers need at least some geriatrics training, said Barczi, clinical director of geriatrics at UW.
"There will never be enough geriatricians to care for the large cohort of older Americans," he said. "We need to be more intentional to ensure that everyone has some basic exposure to the nuanced care of the elderly."
That's the goal of recent initiatives at the UW School of Medicine and Public Health at Madison's Veterans Hospital and a group led by Marquette University that shares a federal geriatric force donation.
Older adults "have complex health needs that not all providers are prepared to handle," said Stacy Barnes, a Marquette nursing professor who leads the federal grant project. He recently began training paramedics to recognize signs of dementia and ways to calm patients who have it.
Talking with older patients
UW began demanding that medical students make a two-week unit in geriatrics this year. A one-month geriatric rotation for internal medicine residents, long available as an elective, has become mandatory for about five years, Barczi said.
In addition to instructing students and residents about falls, dementia, depression and other topics that particularly affect the elderly, programs emphasize communication with the elderly, he said.
Doctors should talk to elderly patients first, even if they have dementia, when caregivers are also present during consultations, Barczi said. With older patients, doctors may need to speak louder and slower and emphasize some key issues, rather than mentioning all the points.
"You can not go through 10 items in 25 minutes," he said.
At Madison VA, nurses, pharmacists, social workers, psychologists, and speech pathologists can obtain certifications in geriatrics. A geriatrics program, which is also available in some other VAs scattered throughout the country, provides intensive training to a dozen providers each year and involves workshops for others in rural clinics.
Dr. Paul Mannino, a family practice physician at the VA clinic in Rockford, Ill., Spent a week at geriatric clinics in Madison last year through the geriatrics program. Through the program, he enrolled some of his Rockford patients on telehealth monitoring to try to keep them out of the hospital.
Now, "I'm less afraid of managing complex geriatric patients," Mannino said.
Geriatrics workforce grant
UW and Marquette, along with the Wisconsin Medical School, Aurora Health Care and the Alzheimer's Association, are partners in a $ 3.4 million federal grant from the Geriatric Workforce Improvement Program , which will last until next year.
Through donation – one of 44 nationally – the Faculty of Medicine has developed online courses on drug interactions and advanced guidelines that providers can make to meet continuing education requirements.
Sixteen nurses at two Aurora hospitals received intensive training to work with older adults, Barnes said.
Reference guides for insomnia treatment, interpretation of cardiac monitor changes, diagnosis of osteoporosis and other topics are available to providers at geriatricfastfacts.com.
The Southeastern Wisconsin committee of the Alzheimer's Association has trained emergency responders from the city and county of Milwaukee, 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 keep people with dementia from entering the criminal justice system unnecessarily, could expand to other parts of the state if the coalition gets another federal grant after next year, Barnes said.
At UW, the recent Weiss training session under the guidance of Barczi was also supported by the donation. UW and VA are designing a virtual version that could make this training more available in rural areas, Barczi said.
In another in-person training session last month, Dr. Emily Owen, also a first-year resident in internal medicine, evaluated an 87-year-old patient – played by John Smith, 82, of Madison – for dementia.
He said he had left his stove several times and forgot to pay some bills, causing him to move with his son and his daughter-in-law. Owen asked a series of questions and said he would call the family to a social worker.
Dr. Sanjay Asthana, UW's chief of geriatrics and director of the University of Wisconsin Alzheimer's Disease Research Center, praised his assessment.
But he said that it is important to determine if the memory deficiency is short or long. One way is to ask whether patients are taking sleeping pills, such as Tylenol PM, which may cause temporary cognitive lapses, he said.
"Always remember medications," Asthana said.
This article was supported by a journalism grant from the Gerontological Society of America, the Journalists Network on Generations, and the John A. Hartford Foundation.