To truly learn geriatrics, medical students in Maine live in nursing homes for a month

From The Boston Globe:

Matthew Sharbaugh (pictured) checked himself into a nursing home recently, complaining of chronic pulmonary obstructive disease, congestive heart failure, and right-side weakness from a recent stroke. He is 24.

Sharbaugh had signed away his youth for the next 12 days to play the part of an 85-year-old man in ailing health at the Old Soldiers’ Home in Chelsea.

A second-year student at the University of New England College of Osteopathic Medicine in Biddeford, Maine, Sharbaugh is one of six students living in a New England nursing home this summer as part of the school’s Learning by Living experiment, founded in 2005 to provide students interested in geriatrics with firsthand experience of the care of the elderly. This year is the first the program has expanded to include a facility in the Boston area.

Sharbaugh, who keeps a daily journal chronicling his observations, said last week: “I never really noticed how hard it is to live like this. I just always thought of old people as grumpy people who are easily upset.’’

By his fourth day, Sharbaugh, of Simsbury, Conn., came to appreciate the patience needed to cope with the daily frustrations facing wheelchair users: a misplaced TV remote, a notice posted too high.

Adjusting to his new life took time. His wheelchair beeped alarmingly every time he tried getting up or shifting his weight. His diet of pureed foods did little to satisfy his appetite. The first time he showered, he was unable to turn his wheelchair and ended up washing just the left side of his body.

Going to the bathroom became an art. With a twinge of shame, Sharbaugh learned to coordinate his bathroom trips with nurse shifts to avoid asking the same care provider for help more than once.

From his wheelchair, Sharbaugh also picks up on details that can enhance or detract from the quality of care for elderly patients.

He notes the importance of communicating at eye-level with the patient, of explaining medical procedures to the elderly and not simply to their adult children.

“It’s extremely difficult to hear the medical jargon and not know what it refers to,’’ Sharbaugh wrote in his journal. “When I have my practice, I will have to be sure to explain the patient’s care in terms that he or she will understand.’’

Established by his gerontology professor, Marilyn Gugliucci, Learning by Living is billed as the only program in the country that allows students to live for two weeks as patients in participating nursing homes, which willingly forgo the revenue, roughly $300 a day for 12 days, to support the initiative.

Gugliucci, who is the College of Osteopathic Medicine’s director of geriatric education and research, said she hopes to expand the program into a national fellowship for students interested in geriatrics.

Geriatrics remains one of the most underrepresented fields in medicine, according to the American Geriatrics Society, and medical school curricula often require little to no geriatric training.

But with the first of the baby boomers rapidly approaching 65, most medical students will end up treating elderly patients, regardless of their medical specialty.

“It’s difficult to treat a person when you don’t really have a great handle on how that person feels, what they go through day after day,’’ said Gugliucci, who has been analyzing the students’ journal entries over the past few years. “In every case, students have looked beyond chronological age, frailty, and disease, and even dementia, to connect heart to heart with the people they lived with.’’

Keenly aware of the shortage of certified geriatricians in the nation, specialists laud the program as an innovative way to generate interest in elderly patient care.

“It can be a challenge for young people who are functionally and cognitively intact to get a sense of what an older patient is experiencing,’’ said Sharon Brangman, president of the American Geriatrics Society. “Just about all medical students are going to take care of older people in their careers, and we really have to find a way of integrating some level of geriatrics into the medical school curriculum.’’

Treating elderly patients, many of whom suffer from several chronic diseases, requires a more patient-centric approach than students may expect, said Robert Schreiber, physician in chief at Harvard affiliate Hebrew SeniorLife.

If the students can really relate to the nursing home resident’s life and challenges, “it will help make them better doctors, make them better able to care for this frail population,’’ Schreiber said.

Sharbaugh has not decided whether he will specialize in geriatrics, but his experience thus far has already shattered many of his notions of nursing home life and care.

“I expected just to be bored out of my mind, to just sit there waiting and waiting and waiting,’’ Sharbaugh said. “But I haven’t had a free second at all.’’

The 500-page book he had brought with him for his 12-day stay remains untouched. He busies himself with daily activities ranging from arts and crafts to bingo to poker night, even winning $5 the first night.

He has slowly worked his way into the tight network of military veterans living at Old Soldiers’ Home, piecing together the likes and dislikes, the memories, and daily conversations that make up the residents’ lives.

His lunch buddy likes tanning his knees in the sun room. Another knows every word to the ballads played during music time.

By the end of the week, Sharbaugh was no longer the outsider observing nursing home life; he had become friends with his fellow residents through the exchange of food and simple gestures such as fixing a neighbor’s broken razor.

“He had saved me his food from the outside that he only gets once a week’’ when his family visits, Sharbaugh wrote. “The fries were cold and terrible, but I was so happy that he had thought of me. I am really making friends.’’

The emotional bonds that Sharbaugh formed with the nursing home residents, he said, have shaped the way he now interacts with patients.

“There is a face and story behind every patient,’’ Sharbaugh wrote. “The patient should not be viewed by the conditions that ail them, but by the person beneath the disease.’’