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Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Vital Signs

DMS students find elders "kind" and "witty"

By Alissa Poh

Preparing for situations like this was the goal of the evening.

Hanging out with a bunch of retirees doesn't sound like the way a group of medical students would choose to spend a free evening. But at Hanover's Kendal retirement community, eight DMS students have turned out for Skills Night. They're there to learn some of the clinical skills involved in geriatrics, and Kendal residents have volunteered to act as patients.

The students and volunteers first get to know each other over dinner. "We had surprisingly deep conversations," DMS first-year Regina Duperval says later, "and they were really kind."

After dinner, the students get to work. They'll focus on cognitive function and mobility, says Dr. Stephen Bartels, director of the Dartmouth Centers for Health and Aging, since "memory loss and falling are common problems with aging."

Gait: In one room, physiotherapist Nancy Evans shows students how to assess an elderly person's gait, speed, and balance. "On the word 'go,' walk toward this line, then return to your seat," says a student to Kendal resident Bill Griffen. He obligingly shuffles three meters to and from his chair in 11 seconds, indicating good mobility; a frail person might take two minutes or more. "Well, I've had both hips and a knee replaced," Griffen quips, drawing chuckles.

Meanwhile, Dr. Linda Dacey is demonstrating how to record changes in resident Wiggy Grassi's blood pressure as she sits upright and then stands. If the pressure drop between positions is greater than 20 points, Dacey says, it indicates orthostatic hypotension, meaning the patient is more likely to fall.

Risk: "One in three people over the age of 65 falls each year," explains Joanne Cook, a nurse practitioner at Kendal. "So it's important to understand risk factors for falls and how to screen for them."

A third group of students is carrying out mental status tests, guided by Bartels. Kendal resident Hershner Cross confidently names 23 different animals in a minute, showing "spontaneous recall of well-learned information," Bartels says. Cross also has a good grasp of spatial relations, easily drawing the hour markers and a specific time on a clock face. But when told a story and quizzed on the details afterward, he comes up short. It's an attention issue, Bartels explains.

Memory loss and falling are common problems with aging.

"My 'patient' was in his mid-nineties," says first-year student Kevin McNerney. "I was really struck by how witty he was. It was remarkable . . . to see that he hadn't experienced much of a mental decline at all."

"We'd discussed such tests in class, but we hadn't yet moved from theory to practice," adds second-year Amy Thomas. "Actually doing the assessment helped me to understand how it works."

Duperval is glad she attended. "I'd never considered geriatrics before, but now I'm starting to see it as a [career] option," she says.

Thomas, on the other hand, has long planned to specialize in geriatrics and worked closely with several faculty members to organize Skills Night. She credits her interest in the field to growing up with both sets of grandparents and three great-grandparents.

"One of the fastest-growing segments of our population is people 80 and older," Thomas says, "so we need to be trained to understand the unique challenges of treating these patients." She hopes Skills Night will become a yearly event and help change the perception among her peers that geriatrics is stodgy.


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