$1.9 Million Grant From Reynolds Foundation Aimed At Improving Care of Older Patients

May 25, 2001

Doctors in Rochester are launching an effort to better train doctors to take care of older patients, thanks to a $1,999,346 grant from the Donald W. Reynolds Foundation to the University of Rochester School of Medicine and Dentistry.

Robert McCann, M.D., chief of medicine at Highland Hospital and associate professor of medicine at the University, is the principal investigator for the program. Among the initiatives: a greater focus on care for the aging as part of the education of future doctors; an effort to encourage more doctors to specialize in care of older patients; partnerships with community physicians who treat older patients; and house calls by young doctors so they can see for themselves the challenges that aging patients face in their own homes.

"The fastest-growing portion of the population is people over 85 years old," says McCann. "This work is something that most people have a vested interest in. We'll all become older - if we're lucky - and we'll all want physicians as capable and attentive as possible."

Other doctors who are shaping the program include Annette Medina-Walpole, M.D., assistant professor of medicine at the University and also associate medical director at Monroe Community Hospital, and Nancy Shafer Clark, assistant professor in the Department of Medicine at the University and at Highland. All three physicians are geriatricians who specialize in the care of the aging.

The funding will enhance the medical school's new Double Helix curriculum that intertwines basic science and clinical experience, which has been cited nationally as a new and effective way to train future doctors. Aging is one theme that students study throughout their four years of medical school. Students will study what happens to our body's cells and organs as patients age, and they will have increased opportunities for treating aging patients in area hospitals. Among the new efforts, students will visit patients in their homes and keep a journal of their experiences and the patient's health as they witness first-hand the aging experience. They'll also have more of a chance to rub shoulders with doctors who specialize in geriatrics; with the booming population of older Americans, a shortage of geriatricians looms.

"Many students have had important and meaningful interactions with grandparents or other older persons in their lives, and they may be interested in geriatrics," McCann says. "But since there are so few geriatricians, many students don't have role models or mentors to show them how fulfilling it can be to work with older patients. We hope to provide those role models."

Part of the four-year program will focus on what happens to older patients once they leave the hospital, a process that usually falls to new doctors. "Oftentimes young doctors aren't aware of the many difficulties that can be encountered by aging patients and their families upon discharge," says McCann. "Usually they never see the patient again."

When a patient is discharged, the doctor assesses the patient, asks about social supports, and explains medications; as part of the new program, some such interactions at Highland Hospital will be videotaped, and the doctor will predict what will happen to the person. A few days later the doctor will actually go to that patient's home and see how things are going, and that interaction will also be videotaped.

Later the doctor will present the case to his or her peers, who will also try to predict the outcome based on the initial in-hospital visit. Then students will hear and see the details of the subsequent house call and can check how well their predictions stack up against reality. One particular area of interest, McCann says, is how well patients are able to take their medicines as their doctors recommend.

"It's striking how many medicines some people are sent home from the hospital with. One day I heard a resident doing a discharge summary, and she dictated 19 different medicines the patient was on. I asked her what she thought the odds were of the patient taking those as scheduled, and she hadn't really thought about it.

"For some patients it's almost impossible to take their medicines as prescribed. Sometimes in geriatrics, taking away medicines is a therapeutic intervention just the same as giving medicines is. Our residents will have the chance to see how people actually fare on these regimens when they leave the hospital."

Part of the grant will go toward greater interaction with community physicians, who have a great deal of contact with aging patients in Rochester. The medical school will set up short conferences where doctors can learn from each other's experiences, and where medical students can take advantage of the knowledge and experience these doctors bring to the care of the aged.

Earlier in his career McCann spent some years treating patients in an emergency department, an experience that focused his interest in geriatrics. "It was a good vantage point to see many of the bad things that happen to older people. They might come in on 15 different medicines from three different doctors, none of whom were talking to one another, and I realized some of the challenges in caring for older persons."

Thus he helped to create a program, Independent Living for Seniors, that allows elderly and frail individuals to continue to live in the community instead of moving to a nursing home. The program at Rochester General Hospital has been recognized nationally for its success and is part of the reason Rochester is known for its outstanding care of aging residents. The city also features an innovative program begun by Strong Health where doctors, geriatricians, and nurse practitioners work together to care for patients in nursing homes and assisted-living centers. And at Highland Hospital McCann created a specialized Acute Care for the Elderly (ACE) unit that pays special attention to the needs of elderly patients.

The grant to the University is one of 10 awarded this month by the foundation to strengthen physicians' geriatrics training across the nation.

The Donald W. Reynolds Foundation is a national philanthropic organization founded by 1954 by the late media entrepreneur for whom it is named. Reynolds was the founder and principal owner of the Donrey Media Group. When he died in 1993, the company included over 70 businesses, the majority of which were in the communications/media field. Headquartered in Las Vegas, it is one of the largest private foundations in the United States.

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