New Tech, New Tricks
It sounds ironic: improving health care for the oldest of patients using the newest technologies that those same patients probably once considered science fiction.
But as Dr. Donald Jurivich and his colleagues have already shown, it’s the latest digital platforms—video games, social media, virtual training modules—that are the future of education in geriatrics care in the United States.
“Too often, medicine for the elderly means multiple prescriptions to treat symptoms rather than the person or condition,” explains Jurivich, chair of the UND School of Medicine & Health Sciences (SMHS) Department of Geriatrics. “Prescriptions accumulate, and if someone has more than six medications, they’re considered to have ‘polypharmacy’ and are also at risk for falls, cognitive impairment, hospitalization, and maybe death.”
Combatting this business-as-usual approach for elderly patients has been Jurivich’s mission for several years now. And he says at least part of the solution to problems emerging in eldercare is not only better provider education, but also new technology.
Posts, tweets and games
In 2018, for example, Jurivich and his team published a report in the Journal of the American Geriatrics Society that described “quizzing” medical students via Twitter. Students who were quizzed on geriatrics care, it turned out, nearly doubled their geriatrics knowledge relative to their unquizzed counterparts.
On the strength of that interdisciplinary research, Jurivich applied for and was awarded in 2019 a $3.75 million grant from the Health Resources & Services Administration (HRSA) to advance geriatrics education and health care transformation in North and South Dakota, through the strategic use of digital platforms in particular.
Assembling a group of institutions—including the North Dakota State Division on Aging Services and Health Promotion, Center for Rural Health, Alzheimer’s Association of North Dakota, North Dakota State University, and South Dakota State University—into what he calls the Dakota Geriatrics Workforce Enhancement Program (GWEP), Jurivich hopes the grant will help providers in the two states improve knowledge about older adult health care generally, and therefore make local communities and health systems more “age-friendly.”
“Our first aim is to create online training modules in older adult care for providers,” says Jurivich from his office at the School in Grand Forks, describing platforms that can address overmedication, geriatric syndromes such as falls, bladder incontinence, and memory loss, and communications with older adults and cognitively impaired people. “The second goal is trying to harness social media for geriatric knowledge and education. Much of this is driven by student usage. Students tend to use Instagram more than Twitter, so we need to tailor the platform to the learner to optimize their exposure to geriatrics.”
In addition to harnessing social media for geriatric knowledge and education, GWEP is looking to facilitate group webinars and call-in sessions on eldercare through a platform called Project Echo that can enhance the School’s “telementoring” capacity and develop a virtual video game for trainees to intervene in the health care of patients with different geriatric syndromes.
“We’re creating a game where clinicians prescribe treatment for a panel of patients whose age and health status reflect the general population,” adds Rick Van Eck, associate dean for Teaching and Learning at the SMHS and the School’s Dr. David & Lola Rognlie Monson Professor in Medical Education. “Physicians can see the impact of their decisions every five years or so as patients ‘age’ over time in an accelerated way, allowing them to see patterns in patient populations within minutes that would otherwise take 40 years to emerge.”
Although boasting a population with a relatively low median age (35.4 in 2018), North Dakota also has the fourth-oldest elderly population in the U.S. among those age 85 and up.
This is why it is imperative, continues Jurivich, not only that North Dakota addresses its shortage of geriatricians statewide, but makes its health systems and communities more age friendly.
“Age-friendly health systems consistently adhere to the geriatric ‘4Ms’ with each patient encounter,” Jurivich says, referring to the four principles that guide geriatric medicine: (what) matters, mobility, mentation (attention to dementia and cognition), and medication. “With each encounter, the provider should examine the status of these 4Ms for the patient in question and adjust the care plan as needed.”
Likewise, Jurivich says that age-friendly communities are those that emphasize programs and services that help older adults age “in place” and remain as functionally independent as possible for as long as possible. Such programs include Meals on Wheels, physical activity and fall prevention programs, and Alzheimer’s awareness/education efforts.
“We know, for example, you need to control your blood pressure and engage in cognitive thinking, games, and physical activity to reduce your Alzheimer’s risk,” says Jurivich. “Given that one-third of the population is obese, though, they’re at extraordinary risk for Alzheimer’s. Addressing those kinds of problems early at the community level jump starts the whole prevention process. Because once the cat is out of the bag for Alzheimer’s, we have no treatment—only palliative care.”
Making aging a thing of the past
Jody Ward agrees.
“We did a series of six palliative care sessions recently for providers across the state via Project Echo,” says Ward, a nurse by training who is now a Minot, N.D.-based senior project coordinator for the UND Center for Rural Health (CRH). “Those topics crossed over into geriatrics and the age-friendly health system. That was a big success, and we’re all ready to go on multiple topics on this.”
Ward works on patient safety and quality improvement with the Center for Rural Health and the state’s 36 critical access hospitals. She and her team are already working on the age-friendly-community side of Dr. Jurivich’s HRSA grant in Hazen, Beulah, and Killdeer, N.D., with Sakakawea Medical Center and Coal Country Community Health Center.
“We have a very Midwestern mentality in North Dakota where we like to have a shared voice across the state,” says Ward, referencing the state’s hub-and-spoke health system model where the six tertiary care centers in the four major cities provide assistance to the state’s rural communities in a networked way. “That’s the framework we’re thinking about for doing more across the state with the 4Ms, which is a national movement. A lot of these pieces are already being done here, but we can still identify gaps of care and get team members thinking with the same mindset to meet elderly needs.”
In the end, it’s not entirely clear who the old dog is here in the cliché about teaching new tricks—North Dakota’s elderly population or its medical establishment?
Dr. Jurivich says maybe it’s both.
“There’s a line among geriatric health providers that puts all of this into perspective,” he laughs, thinking too of the NIH’s Dog Aging Project, which is studying aging in man’s best friend. “‘Aging: If it’s not your issue, it will be.’ Our mission, as a department is literally to make aging a thing of the past. Ultimately, we want to have healthy longevity, which is the longest lifespan possible, for everyone. This requires the education of everybody from the public to caregivers, students and trainees.”