Title:The Silver Lining

Georgetown trains the next generation of health leaders in the field of aging

Three years ago, with two graduate degrees and nearly 25 years of experience in higher education administration under his belt, one law school dean had his eye on retirement.

In his mid-50s at the time, attorney Scott Foster (L’93, G’21), then a senior administrator and assistant dean at Georgetown Law, was looking to recharge his batteries and possibly pivot to a new career.

Equipped with a good sense of his strengths, Foster wasn’t certain how he wanted to apply them. He was pleased and not entirely surprised when an aptitude test surfaced the field of assisted living and nursing home management. Wth his background in administration, and the knowledge that the field
of aging services was becoming prominent, the results resonated with him immediately.

Foster recognized he would need more specialized education. Georgetown’s new Master of Science in Aging & Health, launched in 2018, fit the bill perfectly.

Now 57, Foster is the oldest person in his cohort. Proudly so, he notes, despite feeling somewhat rusty in terms of writing academic papers and adjusting to being back in a classroom.

“The program was actively looking for a range of ages, so the fact that I was in my mid-50s was a plus,” Foster says. “I believe that the expertise I gain in the program, coupled with my long career as a senior-level administrator, will ideally position me for a new career in the field of aging.”

Reframing the Aging Process

The topic of aging has enormous implications for our society. In the next four decades, the number of Americans aged 65 or older is projected to nearly double, from 52 million in 2018 to 95 million, according to the Population Reference Bureau. This means that nearly one in four Americans will be 65 or older by the year 2060.

This impending demographic transformation has garnered nicknames such as the “silver tsunami,” evoking the image of a massive wave of senior citizens on the horizon.

Yet when we frame aging as a looming problem, we miss the opportunity to engage people of all ages in a more productive, positive way, according to Pamela A. Saunders, PhD. An associate professor in the departments of neurology and psychiatry at Georgetown University Medical Center (GUMC), Saunders is founding director of the new graduate program.

“We have a unique challenge to address a population that’s going to have a lot more older people than it has in the past—and that’s a good thing. We’re living longer. We’re healthier,” Saunders says. “Modern medicine has helped us to reach an older age, but these population changes affect all of society, so we need to consider what they mean for all of us.”

The aging population raises myriad economic, workforce, housing, and health care questions and opportunities, and Saunders hopes the new program will help prepare students to respond to them.

Intergenerational Dialogue

Now in its second year, the graduate program is attracting students from a wide variety of backgrounds and experience levels, cultivating a “dialogue between multiple generations,” says Vi Nguyen, the program coordinator.

“They’re learning from each other. The program naturally attracts people from different age groups, so it leads to inter-generational collaboration,” Nguyen says.

Some, like Foster, are attempting a career pivot or reinvention, while others are just starting out.

At 24, Darya Rahbar (G’20) is the second-youngest person in her cohort. She says she has always had a “soft spot for older adults.” After realizing early on that a career in primary care wasn’t for her, she enrolled in the Georgetown graduate program, ultimately deciding on a concentration in Health Care Economics and Policy.

While she was initially intimidated by a multi-generational classroom, Rahbar now says it is one of the aspects of the program she values most.

“I’m benefitting from it immensely. I’m learning from those people who have a different life perspective that comes from more experience, but I also feel like I am bringing something to the table,” Rahbar says. “I feel more empowered than I expected to step up and meet people where they are and have them meet me where I am.”

She adds that she and her colleagues share an “underlying curiosity and a profound respect for older adults and the process of aging.”

“A lot of people are scared of aging, but in this class there is a genuine fascination. People are not afraid to ask questions and push boundaries in terms of their respect for one another and for this population,” says Rahbar.

Another strength is the program’s interdisciplinary approach, notes Foster. Faculty members bring expertise from departments across the university, including the School of Medicine, the School of Nursing and Health Studies (NHS), the Law Center, and the McCourt School of Public Policy. A highlight for Foster has been an elective in elder law, which connected to his legal roots.

A monthly seminar series features speakers from various university departments, as well as local and national experts. From GUMC, speakers from the spring semester have included NHS Interim Dean Carole Roan Gresenz, PhD, discussing the effects of early-stage Alzheimer’s disease on household financial outcomes, and R. Scott Turner, MD, who directs the Memory Disorders Program (see story here for more on these researchers).

Saunders says the interdisciplinary approach helps ensure that, rather than seeing older adults as a one-dimensional “problem” to deal with, students view them as people with lived and living experiences who bring complexity and richness to the world.

“Older adults tend to get discriminated against, but we want to reframe that so we begin to think and talk about the accumulated wisdom and knowledge and experience, and how to put it to good use rather than putting it on a shelf,” she says.

Teaching Aging in Medicine

Beyond the MS program, Georgetown’s efforts to teach students about aging are woven throughout the medical and nursing curricula.

According to Mary Furlong, MD (MS’91, M’95, R’00), senior associate dean for curriculum at the School of Medicine, the topic is not broken out as a separate unit, but rather is fully integrated into the preclinical curriculum, for example in the central nervous system module and pharmacology course. The aging lens can be applied to almost any disease or condition.

The School of Medicine also places a heavy emphasis on bioethics, where medical students learn about issues related to palliative and end-of-life care.

Furlong is an advocate for exploring how the topic of aging can be better represented across students’ four years. “I feel very strongly that we need to be educating our medical students about this topic in a variety of ways. Anyone who has a parent or relative who is aging or dying can tell you how crucial it is,” she says.

Once students begin their clinical training, they encounter aging across several different compulsory clerkships, including family medicine, neurology, internal medicine, and obstetrics/gynecology.

In addition, approximately 20 third-year medical students each year choose to do a two-week geriatrics clerkship. The goal of this elective is to have students see older people not just as patients in need of care once they are sick, but also as people who have needs while they are well.

“To study the aging process is really just to study people,” says Saunders, who directs the geriatrics clerkship in addition to the masters program. “Geriatrics focuses on a range of health-related issues for people in mid to late life.”

As with many clerkships, the geriatrics one culminates in what is known as an objective structured clinical examination (OSCE), a simulated exercise in which an actor presenting as a standardized patient tests competency in areas such as clinical skills, communication, examination technique, and other facets.

“We do one case with an older adult who has problems sleeping, and the student has to talk to the patient to find out what’s going on and come up with a plan. Then the older adult gives them feedback based on their communication skills,” Saunders says.

On top of these efforts, the School of Medicine is using virtual reality software at its Dahlgren Memorial Library that provides students a sense of what aging patients experience—by enabling them to virtually enter the body of a patient who is experiencing age-related conditions such as macular degeneration or hearing loss, cancer and end-of-life issues, or memory loss (see story here).

The Value of Home Health

At NHS, aging is threaded throughout the various undergraduate and graduate degree programs as a part of overall care.

One standalone course, available to undergraduate as well as some masters- level nursing students, is devoted to studying older adults. In one assignment, which is premised on the District’s Department of Aging and Community Living Safe at Home Program, students conduct hypothetical assessments of home environments. The goal is to determine if they would be safe for older adults to return to after being treated in the health care system.

“Nursing students are usually doing clinical care in an acute care setting such as a hospital, so they are not in people’s homes. Therefore they don’t really appreciate all the issues in the home that can contribute to or impede someone’s health and well-being,” says Margaret Granitto, ANP-BC, CNL, an instructor in the department of professional nursing practice and coordinator for the course on older adults.

“This drives home the point that you might be taking care of someone in the health care delivery system, but you are going to be transitioning them somewhere else that might be fraught with danger,” says Granitto. “If you need to discharge someone with a broken hip, what does their home look like? Do they need to go up and down stairs? These are the types of issues we want students to be thinking about.”

NHS also offers an advanced distanced-based degree in aging, the Adult-Gerontology Acute Care Nurse Practitioner specialization, as part of the Master of Science and Doctor of Nursing Practice programs. This curriculum prepares registered nurses for leadership roles as providers through case studies, standardized patient experiences, and high-fidelity simulation, according to Kelly Thompson-Brazill, DNP, RN, assistant professor at NHS who directs the program.

“Complicated psychosocial issues, such as an acutely ill older adult patient signing out of the hospital against medical advice to care for a terminally ill spouse, are built into each learning activity,” Thompson-Brazill says. “Students are expected to competently manage each patient’s clinical condition using current medical evidence and guideline-based care, while providing patient- and family-centered care.”

 

Building Community Connections

An education in aging at Georgetown often means getting out of the classroom and into the community.

All first-year medical students at Georgetown take a community-based learning (CBL) course, where they can choose from an array of initiatives in the DC area to gain a deeper understanding of a specific population—typically one that is medically underserved. Each year, about 40 students out of nearly 200 choose a CBL related to older adults, where they design and lead activities with older adults and staff at various sites.

According to Donna Cameron, PhD, MPH, professor of family medicine in the School of Medicine who has run the CBL course for the past 20 years, these experiences resonate deeply with students year after year.

Students are often surprised by how connected they feel to the older adults through these visits, notes Cameron.

“This is the kind of exposure we want our medical students to have and to receive. We want them to experience bringing joy to people who are not sick and to learn about the lives of older adults before they become ill and seek medical care,” Cameron says.

“That patient in Exam Room 2 has a family, a life, a career,” she adds. “All of those influences can impact your diagnosis and plans for treatment. One of the objectives of the CBL course is to understand the factors of one’s everyday life that help to determine a person’s health status before they become a patient.”

At IONA Senior Services, a CBL site located in northwest DC, a small group of first-year medical students collaborate with staff to devise activities for folks in their memory disorders day program.

“What’s so important for the participants is that they are being challenged, and their senses are being stimulated through different types of art-based activities,” says Julia Langley, who brings the students there each year. In addition to teaching at the medical school, Langley is the faculty director of the Arts and Humanities Program at Georgetown Lombardi Comprehensive Cancer Center.

“For different but related reasons, the time the students and the participants share together is an amazing gift,” Langley says. And even though they may not remember the students’ names each time, the seniors eagerly anticipate their visits with Georgetown medical students.

“The students who work with the participants are learning the importance of being present,” notes Langley. “They don’t have to be talking, they don’t have to know everything, they just have to pay attention and be there.”

Georgetown University Aging-Related Programs and Resources

AgingWell Hub at the McDonough School of Business
A collaborative of diverse organizations focused on research, partnerships, open innovation and shared frameworks to improve products and services for the aging population and their caregivers

Virtual Reality Training at Dahlgren Memorial Library
Immersive technology that allows students at the School of Medicine to step into the aging patient’s experience using a headset and software (see story)

Association of Retired Faculty and Staff
A group that supports emeriti members’ professional endeavors, facilitates social ties, and provides volunteering and community outreach opportunities

Georgetown University Learning Community Program
Series of non-credit mini-classes for individuals 55 or older taught by volunteer retired faculty and others on topics such as politics, art, literature, and science

Senior Citizen Non-Degree Audit Program
School of Continuing Studies offers people over 65 the opportunity to audit undergraduate level courses chosen from the regular course offerings

Mini-Medical School
A twice annual community-oriented 8-week lecture series that allows area residents (including but not limited to retirees) to explore various areas of the basic and clinical sciences that mirror Georgetown medical school topics

Doctors Speak Out
Quarterly luncheon series inviting local residents (including but not limited to retirees) to hear directly from university experts about advancements in biomedical science and implications for medical practice

ROMEOS: Retired/Retirement-Approaching Old Medics Eating Out
Informal social group of physicians who meet monthly for lunch and lectures, and who are trained by or connected with the School of Medicine and MedStar Georgetown University Hospital