Caring for the medical needs of older adults, age 65 and older, requires skills that can’t be fully taught in the classroom. According to Dr. Mariana Dangiolo, Assistant Professor at the UCF College of Medicine and a geriatric and family medicine provider at UCF Health, there are certain things that can best be observed in the patient’s home. This is the basis for her “Bridging the Gap” clerkship with third-year med students at UCF – to allow them to provide patient care in the patient’s home to bridge the care they receive at their regular appointments.
“I wanted to show med students how assessing someone in their home environment can yield different outcomes than if the patient was seen only during an office visit,” said Dr. Dangiolo. “It also gives students a greater appreciation for home healthcare and enhances their screening skills with this unique population.”
The program was originally funded by LIFE at UCF, an organization providing lifelong learning experiences for adults age 50 and older on the main UCF campus. The goals of the pilot study were to measure the impact of the program on medical students’ attitudes toward the elderly and the impact on the quality of life of participating seniors.
Early results from this first round show that med students developed a deeper understanding of the complexity of caring for older adults. The patients benefited, too. Participants stated that they felt at ease to ask the med students questions they may not have asked their physician. Another common theme was that participants felt more educated about the side effects of their medication after working with M.D. students.
Through the program, med students complete weekly rotations at Watercrest of Lake Nona, an assisted living and memory care community. Each visit lasts about an hour, and after the visit, students report their case findings and learn from each other’s observations and recommendations. The students and Dr. Dangiolo work with the patients’ physicians on any necessary adjustments to their care.
“Our residents love interacting with the UCF College of Medicine students,” said Jenny Philips, Executive Director of Watercrest at Lake Nona, “and having this relationship is a great benefit for our residents.”
Currently, those age 65 and older represent about 14.5 percent of the U.S. population. In 30 years, that number is expected to grow to 21.7 percent. This highlights the importance of preparing the next generation of physicians with the medical and patient-care skills required by this unique population.
Studies suggest that performing a home assessment of elderly patients who have relatively good health and function leads to the detection of four new medical problems and up to eight new intervention recommendations, on average, per patient. The problems most often detected in the studies include gait and balance problems, immunization deficits and hypertension. These problems can often go undetected at regular in-office medical appointments. During the visits at Watercrest, med students focus on key areas known to have the biggest impact on older adults’ health. These include depression, cognitive impairment, medication review, as well as falls and safety.
The greater level of communication gained through home visits often helps detect issues the patient is experiencing but might not report to their physician. For example, if a patient reports feeling dizzy or tired after changes were made to their medication, the med student works with the patient’s prescribing doctor to make adjustments to mitigate adverse side effects or drug interactions. Often, patients struggle through adverse side effects or stop taking their medication altogether. When adjustments are made to the prescriptions, patients are more likely to adhere to their recommended medications.
Being in the patient’s home also allows the students to assess safety risks that may be present, providing insights most doctors don’t get. When the student sees potential dangers, like not having a lamp nearby in case they need to get up at night, or clutter on the floor, they can make adjustments to mitigate the risk of injury due to falls. This may not seem like a skill doctors need to learn, but each year in the United States, nearly one-third of older adults experience a fall. About one out of 10 falls among older adults results in a serious injury, such as a hip fracture or head injury, that requires hospitalization. Practicing prevention is the best way to protect older patients from this serious health threat, Dr. Dangiolo says.
The geriatric rotation is just one of the focus areas in the med students’ clerkship curriculum. Other areas of focus include general surgery, internal and family medicine, obstetrics and gynecology, pediatrics, psychiatry and neurology. Through community partnerships such as this one with Watercrest, UCF med students experience multiple specialties that help them decide what area of medicine they would like to practice upon graduation.