Grassroots geriatrics – the beginning
I attended a meeting of the Lancaster Lion’s Club in June of 2004. This came about after I was greatly impressed by an e-mail sent to me by one of their members. He stated they were planning to do the “best health fair ever” at a senior apartment building. I called him back, saying I would be happy to help an effort whose goal was “the best”.
What I thought would be an informal roundtable brainstorming session about the health fair turned out to be a regularly scheduled meeting in which two new members were inducted, committee reports read and general business discussed. I was last on the agenda as the “guest speaker”! Fortunately, I had prepared some material to share with the health fair planning committee (which I found out was comprised only of the person that e-mailed me). As I flipped through the handouts looking for something meaningful to talk about, several thoughts coalesced in my mind into a crazy idea I decided to propose to the group.
First, I knew that there would never be enough formally trained geriatricians to care for the rapidly growing older population. Second, my experience as a geriatric consultant for other primary care or specialty physicians told me that recommendations and follow-through with recommendations (by the referring physician) were two different things. More often than not, I end up taking responsibility for my own recommendations, taking on the role of a temporary – and sometimes permanent – primary care physician for the patient. Third, most of the referrals to my practice come from patients (often with family members urging them to call me) who don’t feel their primary care doctors have the time, interest, or knowledge to understand their problems and needs.
The idea was this. Since there would never be enough geriatricians or physicians who could adequately meet the health needs of the aging population, what if older people themselves became more knowledgeable about principles of aging and geriatric care in order to act as self-advocates and watchdogs for their peers?
They could go to a doctor armed not just with a list of general symptoms and problems, but with a partial medical workup already complete. The physician, having concrete information and guided by a patient that is knowledgeable in the general principles (and perhaps some specifics) of the health issues that pertain to THEM, will take up less visit time (certainly agreeable to the doctor given our current health care environment), may induce more interest (rather than causing frustration by appearing as, from the physician’s viewpoint, the “slow-talking, slow-walking, what-do-you-expect-at-your-age” old coot) and obtain some fresh ideas (being taught by their patients) about how they can help their older adult patient population.
The meeting ended with the following initial strategy for the health fair:
1) Send out free self-assessment packets to anyone who requested them (essentially, a modification of the new patient assessment packet I send out to new patients in my practice). Lions Club members would be happy to come out and help anyone who had trouble completed the forms.
2) Individual Lions Club members would become expert themselves in specific important areas of geriatric care (for example, advance directives, caregiving, and polypharmacy). Ideally, the people volunteering for each area would have some personal experience with the area of expertise they were tackling.
3) The health fair itself would take place in a room that had “service booths” set up reflecting the individual aspects of geriatric care. At the “advance directive service booth”, for example, the Lions Club expert would be there to discuss the health care proxy form included in the self-assessment packet, help with completion, talk about their personal experience as to why having a health care proxy designated is so important, and hand out additional forms as needed. Similarly, the “polypharmacy service booth” would have the expert Lions Club member, volunteer pharmacist and pharmacy students, and plastic weekly medication organizers to review the “brown-bag” of medicines that attendees were urged to bring to the fair.
4) Complementing the “service booths”, a holistic medicine physician (who is also a fellowship trained geriatrician – the demand for her services is so high she recently had to close her doors to new patients after only several months in practice), a certified massage therapist, and other volunteer health professionals would be there to demonstrate aroma therapy and acupuncture, give mini-massages, check blood pressures and weights, etc.
This is an experiment which I have great hopes of success, and hopefully can be replicated by other Lions Clubs and interested organizations. If health care professionals don’t currently have the time, interest, or expertise for older adults, we need to promote this type of “grassroots geriatrics” by a population that already has a vested interest, time, and the ability to learn the common-sense basic principles of geriatrics.