Mentors Open Medical Students' Minds About Aging

Beverly Archibald is 86 and she has opinions about what people around her age need from their doctors and nurses. Because she’s a mentor in the SAGE program (Seniors Assisting in Geriatric Education) at the University of North Texas Health Science Center in Fort Worth, she can share her thoughts with medical students and others working toward health careers.

But as Archibald knows, to a large degree she herself is the message the program sends to students.

They might expect eightysomethings to be isolated, ailing or frail. But during the year and a half they’re paired up with Archibald for visits at her condo, they’ll learn that “I’ve got season tickets to the symphony, season tickets to three different theaters and I’m active in my church,” she says. Archibald drives herself most places. And she’s still passionately interested in issues and experiences that have shaped her life, such as zero population growth, the Peace Corps (where she and her family volunteered for several years) and English as a second language, which she once taught.

One pitfall of medical school is that students tend to get only “episodic views” of aging, says Dr. Zaldy Tan, a geriatrician who is assistant dean for curricular affairs at the University of California’s David Geffen School of Medicine in Los Angeles, which is looking at how it could add a mentoring program. “They admit an 80-year-old for pneumonia in the family-medicine rotation and then don’t see that older person again, most of the time ever.”

“Senior mentoring programs,” as they’re known, began cropping up at medical schools in significant numbers about 15 years ago. These aren't mentoring programs in the sense of an older person coaching a younger one on specific skills. Instead, they're a way for older people to help fill in the context and perspective that need to surround med students' skills. The sudden increase in senior mentoring programs was due in part to grants from the Nevada-based Donald W. Reynolds Foundation, which aimed some of its money at improving education for those going into geriatric medicine.

A Reynolds grant was how Dr. Janice Knebl, director of the Center for Geriatrics at the University of North Texas Health Science Center (UNTHSC), started SAGE in 2009.

Back then, the students were all from UNTHSC and most of the mentors came from the local Meals on Wheels program, says Knebl. Her thought was that students would benefit from experiential learning outside of the clinical setting and Meals on Wheels participants would have the advantage of extra visitors looking in on them. “I was trying to get a bit of a two-fer,” she says.

Now, the 1,336 students in the SAGE program come from both UNTHSC and Texas Christian University. They’re from seven degree programs, including pharmacy, nursing, physical therapy, social work and other disciplines. The mentor pool is more diverse, too.

“We’re recruiting from the YMCA Silver Sneakers program,” senior centers, alumni groups, and retirement centers in the area, Knebl says. There are 455 mentors in all.

“The thing that is really important for us as we age is having a sense of purpose,” Knebl adds. “To be able to help educate this next generation of health care professionals really is something that these older adults love.”

What hasn’t changed about SAGE — and is true of many senior mentoring programs — is an emphasis on seeing older people in their own homes.

“I live in a two-story, four-bedroom house,” says Elaine Owen, 90, whose SAGE mentees are invariably surprised by her independence. “Every student that I’ve ever had has been flabbergasted that I live by myself and I do what I do,” she says. She cooks her meals, cleans the house and only last year decided to hire someone to mow her lawn. Owen likes to be outside and when she’s inside, “I think the fact that I live in a two-story house and go up and down stairs numerous times a day, that’s a form of exercise. I just don’t sit all day.”

Her group of three or four mentees comes twice a semester for three semesters, always with a skill they’ve been assigned to practice, such as assessing her cognition or her risk for falling. But there’s also time to socialize and talk about other things. “I’m hoping to open their eyes and say, ’90 is just a number,’” Owen says.

Knebl says, “You miss knowing what’s happening with a patient if you don’t see them in their own home.” In medicine, the terminology attached to that idea is “social determinants of health” and it usually refers to hurdles in a person’s environment that might diminish health. But it could just as well describe environmental factors, goals and motivators that support health.

Owen has bounced back twice from cancer, once from a heart attack and multiple times from other illnesses. “I’ve been hospitalized, but then I come back to my house,” she says. “As long as I’m able, I’d like to stay here.”

About 18 years ago, Dr. Edward Ratner, a geriatrician and associate professor in the University of Minnesota's Department of Medicine in Minneapolis, started a senior mentoring program that had medical students spend a series of afternoons with older people. A decade into it, he realized he was hearing a lot from his students about isolation and loneliness among their mentors. So the program changed. Like Knebl, Ratner saw a chance to solve several things in one fell swoop.

Students moved into the Augustana Apartments in downtown Minneapolis, where their mentors lived — some of them very independently, some with a few support services. Augustana residents got new neighbors and companionship. The building, run by the senior housing and services nonprofit Augustana Care,  filled several apartments that were standing empty. Augustana's social services director got volunteer help from students with recreational activities and other needs that residents had. And the students gained more learning time with elders, a place to live near the university and a discount on rent in exchange for their volunteer work.

Ratner’s program isn’t very big. At most, eight to 10 students at a time have lived onsite. But the program now includes other area schools, and the students are working on degrees not only in health care but social work and ministry.

The trouble with traditional medical education isn’t just that it gives students only episodic glimpses of older adults or that it leaves out all the context of seeing them in their homes and communities. It’s also that every older adult the students see is sick, Ratner says.

“That’s a terribly negative stereotype because most elderly aren’t sick most of the time,” he explains. “If students think that elderly are always sick and disheveled and confused — because that’s how they look when they see them — they won’t appreciate that [older adults] can be a lot better after treatment and they’ll discount the value of even trying.”

He adds, “If the attitude is ‘What do you expect for your age?,' then older people can expect to get poor care from their health care providers.”

Owen knows this firsthand. She quit going to her cardiologist because “I had the feeling I was taking up his time.” With other doctors, too, Owen adds, “they look at me and wonder what in the devil am I doing here at 90 years old.”

Ratner believes the solution ultimately lies in a less segregated society. “Students don’t spend any time with older people in their growing up or in their lives” because by and large “we’ve decided to house our seniors in segregated settings.” In the meantime, senior mentoring programs can help, he says, by giving students exposure to older adults over time, in-depth periods with them and positive experiences with elders who aren’t acutely ill.

Owen agrees with that, too. “I’m hoping that because of a program like [SAGE], these younger people will have a different outlook on older people than the doctors that got out of school 20 years ago,” she says. “All of us are different. They’re seeing that we don’t all fit in one mold.”