Dr. Matthew Weiss, a "patient," an older man playing the role of a 80-year-old with diabetes, told Weiss he recently fell on the bathroom and hit a dresser.
"I've toppled over and banged my head into it on the way down," the man said.
Weiss suggested the man sat on his bed at first when getting up, steady his blood pressure. He checked the man's feet and asked about the medications and throw rugs. When the man said that he drinks two beers every night, and sometimes more, Weiss cautioned that alcohol may increase the risk of falling.
Dr. Steven Barczi, and UW Health geriatrician who oversaw the training session for Weiss, a first-year resident, praised Weiss' performance, including his gentle nudge about drinking. But Barczi said Weiss should have asked about the man's glasses, as outdated prescriptions can also trigger falls.
"Do not forget about vision," he said.
The session – involving Richard Russell, 74, of Madison, who works as a mock patient to help young doctors learn – is part of a growing effort at UW-Madison and around the state to better prepare health care providers to serve an aging population.
Wisconsin's share of people 65 and older, estimated at 895,000 in 2015, is expected to grow to 1.5 million by 2040. That's a 72 percent increase compared to anticipated growth among all ages of just 12 percent.
A state report predicted a shortage of 745 primary doctors by 2035. Last year, a national report predicted a shortage of 27,000 geriatricians – doctors specializing in treating the elderly – by 2025, including 3,430 in the Midwest.
Given the forecasts, it has become clear that all doctors, nurses, pharmacists and other providers need at least some geriatric training, said Barczi, UW's clinical director of geriatrics.
"There's never going to be enough geriatricians to care for the large cohort of older Americans," he said. "We have to be more intentional about making sure everyone has some basic exposure to the nuanced care of older people."
This is the goal of recent initiatives at the UW School of Medicine and Public Health, Madison's Veterans Hospital and a group led by Marquette University that shares a federal geriatric workforce grant.
Older adults "have complex health needs that not all providers are equipped to deal with," said Stacy Barnes, a nursing professor at Marquette who heads the federal grant project. It has recently started training paramedics to recognize signs of dementia and how to calm patients who have it.
Talking with older patients
UW began requiring medical students to take a two-week unit on geriatrics this year. A monthlong geriatric rotation for internal medicine residents, long available as an elective, became mandatory around five years ago, Barczi said.
In addition to instructing students and residents about falls, dementia, depression and other topics that particularly affect the elderly, the programs emphasize communication with older adults, he said.
Doctors should talk with elderly patients first, even if they have dementia, when caregivers are also present during clinical visits, Barczi said. With older patients, doctors may need to speak louder and slower, and highlight a few key issues instead of mentioning each point.
"You will not be able to get through 10 items in 25 minutes," he said.
At Madison VA, nurses, pharmacists, social workers, psychologists and speech pathologists can get certifications in geriatrics. A geriatrics scholars program, which is also available at some other VAs around the country, provides intensive training to dozens of providers a year, and involves workshops for others at rural clinics.
Dr. Paul Mannino, a family medicine doctor at the VA clinic in Rockford, Illinois, spent a week in geriatrics clinics in Madison last year through the geriatrics scholars program. Through the program, he enrolled some of his Rockford patients in telehealth monitoring to try to keep them out of the hospital.
Now, "I have less fear in managing complex geriatrics patients," Mannino said.
Geriatrics workforce grant
UW and Marquette, together with the Medical College of Wisconsin, Aurora Health Care and the Alzheimer's Association, are partners in a $ 3.4 million, four-year federal Geriatric Workforce Enhancement Program grant, which runs through next year.
Through the grant – one of 44 nationally – Medical College developed online courses on drug interactions and advanced guidelines, which providers can take on to meet continuing education requirements.
Sixteen nurses at two Aurora hospitals have been intensively trained to work with older adults, Barnes said.
Reference guides for treating insomnia, interpreting heart monitor changes, diagnosing osteoporosis and other topics have been available for providers at geriatricfastfacts.com.
The Alzheimer's Association's Southeastern Wisconsin Chapter trained first responders from Milwaukee city and county, 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 prevent people with dementia from unnecessarily entering the criminal justice system, could expand to other parts of the state if the coalition gets another federal grant after next year, Barnes said.
At UW, Weiss' recent training session under Barczi's guidance was also supported by the grant. UW and VA are designing a virtual version that could make such training more available in rural areas, Barczi said.
In another in-person training session last month, Dr. Emily Owen, also a first-year internal medicine resident, rated 87-year-old patient – played by John Smith, 82, of Madison – for dementia.
He said he had left his stove on several occasions and forgot to pay some bills, causing him to move in with his son and daughter-in-law. Owen asked a range of questions and said she would connect the family with a social worker.
Dr. Sanjay Asthana, head of geriatrics at UW, and director of Wisconsin's Alzheimer's Disease Research Center, complimented her assessment.
But he said it's important to determine if memory impairment is short or long. One way is to ask if patients are taking sleeping pills, like Tylenol PM, which may cause temporary cognitive lapses, he said.
"Always remember medications," Asthana said.
This article was supported by a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the John A. Hartford Foundation.