A Fellowship of Care: Helping Michigan's Aging Residents Grow Old Gracefully

From Left to Right — Mary Cotton, Frank Komara, Carol Monson, and Mary Hughes

Ensuring that Michigan's aging population will have the qualified care needed to "grow old gracefully" is the goal of a five-year project led by Dr. Carol Monson and her team of researchers from MSU's College of Osteopathic Medicine.

With an $800,000 U.S. Health Resources and Services Administration grant, Monson and her team are establishing a statewide system of osteopathic geriatric fellowships that will be focused on the philosophy of optimal aging.

The timeliness of the project is of the essence, as Michigan's large aging population will grow exponentially as the baby boomer generation begins to enter its golden years. Currently, Michigan does not have enough geriatricians or doctors with specialized geriatric training to provide the needed care. "Many hospitals don't have geriatric fellowships," said Monson. "Our goal is to increase the number of geriatricians in Michigan by growing our own."

Monson is working with the 35 hospital partners that are part of MSU's Statewide Campus System. The intention is for the geriatric fellows, who come out of Michigan's primary care system, to be able to offer a specialized level of care that focuses directly on the needs of the aging.

"There hasn't been a lot of attention paid to folks as they age; what works in someone who's 20 will not necessarily work in the body of a 60, 65, 70 year old," said Monson. "And baby boomers are not content to have what we had in the past; they want a higher level of care. Currently, the perception is that at a certain age, you go to a nursing home, sort of a warehouse for older people."

Many older people, when they retire, become depressed or have no goals, which may lead to them not getting out as much, not exercising enough (or at all), and not eating properly. One aspect of Monson's project is to develop educational modules that address this issue. "Our goal is to repackage curriculum on geriatrics to show students that they can have a piece in making life look brighter," said Monson. This "repackaging" means incorporating into the curriculum an optimal aging approach, which means helping patients live the best possible life they can with whatever health conditions they have, including not just the body but the mind and spirit as well.

This is especially rewarding for Monson. "This is something that hasn't been done, particularly the mind/spirit part," she says. Referring to the philosophy of Andrew Taylor Still, the father of osteopathic medicine, Monson said, "Your aim should not be to find disease in the patient—anyone can find disease. Your aim should be to find health. We want to help them find their interest and show them that they can still do what they want. Growing old gracefully is about doing what you enjoy."

The educational modules are designed to be multi-purpose, covering a broad range of skill levels and variety of aging topics. They are designed to incorporate visits to geriatric homes and other organizations for the elderly, to give students exposure to this group of clients. It is Monson's hope that including geriatric content in undergraduate medical schooling will pique students' interest in working with older people.

The modules are delivered via distance learning, to make them convenient to access statewide. Geriatric fellows at each of the College of Osteopathic Medicine's locations—East Lansing, Macomb, and Detroit—are helping to deliver some of the content. Since fellows already have to make case presentations, they can deliver what they've learned, bringing the educational process full circle.

"Our goal is to disseminate what we do and how we did it," said Monson. "Our statewide campuses have become self-sustaining, producing highly skilled graduate students. As the educational modules are developed and implemented, the hospitals will be able to sustain it."

But there are some barriers to the process. Since there is a shortage of doctors in many specializations, hospitals will use their funding to meet their own needs. "We are trying to show them that it is in their own best interest [to hire a geriatrician]," explained Monson. Many geriatric patients end up being readmitted to a hospital after an initial stay. Now, because new legislation recently passed in Michigan, hospitals may no longer be paid to readmit elderly patients, making it essential to have a geriatrician in place to provide the necessary link between in-patient, ambulatory, and in-home care, so that the chance of the patient being readmitted is much lower. It also provides the hospital some visibility in the community by offering the value-added service of a geriatric specialization.

Monson and her team are working with several community partners on this project: The Michigan Department of Community Health, Office of Services to the Aging; the Michigan Primary Care Consortium; and Blue Cross/Blue Shield, as well as multiple hospital directors.

Kari Sederburg, director of the Michigan Office of Services to the Aging, appreciates the value of this work and is happy to be a part of it. "The work that MSU is doing to engage and educate medical students in geriatrics is extremely important," said Sederburg. "Michigan has seen a decrease in students interested in geriatrics, while we've seen our aging population increase. By 2030, nearly one in four of our residents will be 60 years and older. The team at MSU is doing a wonderful job at connecting students with Michigan hospitals and creating other critical partnerships to do this important work—and we're thrilled to be a part of this effort."

"We are not looking to reinvent anything," said Monson. "We are educating students on what already exists, and then helping them find other avenues for patients to find the variety of care they need to achieve optimal aging. We are teaching them how to look to the community to help support other members of the community—creating a whole 'village' of support, so that we can find a place for them to thrive."

Dr. Carol Monson is continuing to look for community partners who are interested in establishing a geriatric fellowship. If you are interested in partnering with her, she may be reached at monsonc@msu.edu or (517) 355-8724.