People With Early-Stage Alzheimer's Mentor Medical Students To Increase Knowledge And Reduce Stigma

BOSTON, July 17, 2013 /PRNewswire-USNewswire/ -- While the global population is aging, and the personal and economic burdens due to Alzheimer's disease and related disorders are skyrocketing, the number of doctors trained to effectively diagnose and treat people with Alzheimer's is already woefully inadequate. Experts in health policy and practice have indicated the need for more comprehensive education for health care professionals in dementia and aging to meet the needs of the growing number of older adults in the United States.

According to the American Geriatrics Society:

• There are currently approximately 7,500 certified geriatricians and fewer than 1,600 certified geriatric psychiatrists in the United States. It is projected that approximately 30 percent of the 65-plus patient population will need to be cared for by a geriatrician and that each geriatrician can care for a patient panel of 700 older adults. Based on these numbers, approximately 17,000 geriatricians are needed now to care for about 12 million older Americans.
• Due to the projected increase in the number of older Americans, it is estimated that approximately 30,000 geriatricians will be needed by 2030. To meet this need, this would require training approximately 1,200 geriatricians per year over the next 20 years.
• Few graduates of medical schools in the United States are pursuing advanced training in geriatrics. In 2010, a mere 75 residents in internal medicine or family medicine entered geriatric medicine fellowship programs. This is down from 112 in 2005.

"This is a challenging situation for older individuals, families and our healthcare system," said Maria Carrillo, Ph.D., Alzheimer's Association vice president of medical and scientific relations.

At the same time, a program developed by the Northwestern University Alzheimer's Disease Center in Chicago — and replicated now in Massachusetts, Missouri and New Hampshire — provides opportunities for first-year medical students and persons diagnosed with early stage Alzheimer's to participate together in experiential learning programs. In the Buddy Program, medical students are paired with individuals with dementia, and the "buddies" plan a year of regular meetings around mutually satisfying activities. 

These programs are improving medical student knowledge and familiarity with Alzheimer's while also heightening sensitivity and empathy toward people with the disease, according to new data reported today at the Alzheimer's Association International Conference® 2013 (AAIC® 2013) in Boston.

The goals of the Buddy Program are to:

• Educate medical students about Alzheimer's disease by increasing their knowledge base, heightening their awareness of skills and strengths that remain in persons with Alzheimer's and familiarizing them with care/support issues and effective communication skills.
• Introduce students to research and practice opportunities in fields related to aging and dementia.
• Provide persons living with dementia an opportunity to serve as a mentor to a future doctor.

"We want to expand future physicians' knowledge of, interest in and attitudes toward Alzheimer's and dementia in order to increase the number of physicians capable of caring effectively and compassionately for patients with these diseases and their families," said Darby Morhardt, MSW, LCSW, research associate professor in cognitive neurology at the Northwestern University Feinberg School of Medicine.

To date, the Buddy Program has paired 167 medical students and persons with dementia over 16 years. Scores on a Dementia Knowledge Test, created by Morhardt and colleagues in 2000, reveal modest improvement in student knowledge. Analysis of student journal entries, a program requirement following each activity, yield themes that include heightened sensitivity and empathy toward persons with Alzheimer's, increased recognition of remaining strengths and a change in students' preconceptions of dementia.

According to Morhardt, "Many students remark on the comfort and enjoyment they experience with their mentor and for some an increased comfort over the course of the year."

For example, one student wrote, "I feel like my interactions with (my mentor) are becoming more fluid as I begin to ask fewer complex questions and incorporate his viewpoint into my own speech. I also feel more comfortable 'jumping in' when (my mentor) struggles for too long with a word or sentence without threatening his independence. I understand so much more about (my mentor's) experience than I could even imagine before we met."

First-year medical students are selected based on interest and willingness to commit to these program requirements: 1) attendance at two 90-minute orientation sessions and monthly process meetings; 2) four hours per month in activity with their buddy for one academic year; and 3) submission of a semi-structured journal report following each visit. A pre-/post-dementia knowledge test assesses student's objective learning, and student journal entries are qualitatively analyzed for themes.

Three Successful Replication Programs

The program has been successfully replicated at Boston University (2006), Dartmouth College (2010) and Washington University (2012). Each replicating program has integrated unique modifications while keeping the primary elements in place.

The Boston University program (PAIRS, Partners in Alzheimer's Instruction Research Study) produced several innovations, including the use of a textbook geared toward students and non-specialists; an additional comprehensive dementia knowledge test to better assess students' factual learning; scales to measure attitudes toward Alzheimer's and dementia; measures of physician empathy; and an end-of-the-year reflective essay encompassing students' PAIRS program experiences — including what they have learned throughout the program and how they envision that these experiences will affect their subsequent careers.

"Students in the PAIRS program have consistently demonstrated improvement in factual knowledge, as well as gaining valuable new experiences and perspectives related to caregiver and personal aspects of Alzheimer's disease, such as the frustrations of living with memory loss," said Andrew Budson, M.D., director of the education core at the Boston University Alzheimer's Disease Center. "Students' empathy for patients and caregivers has increased, and they report decreased stigma and negative attitudes toward people with Alzheimer's."

The Dartmouth TALES (The Alzheimer's Learning Experience for Students) program has modified the structure of the Northwestern Buddy Program in the following ways: (1) In addition to first- and second-year medical students, Dartmouth College pre-medical students and master of public health students are permitted to enroll in the program; (2) two students are paired with each person with Alzheimer's and generally visit the person with Alzheimer's together; and (3) students in the program are given a survey of attitudes about Alzheimer's disease before beginning the program and after completing it. Nine medical students, 11 graduate students and 42 undergraduates have enrolled since the program began in 2010.

"While our students typically enter the program with generally positive attitudes toward Alzheimer's disease and those who have it, the experience of being in the program further improves their attitudes on nearly every dimension that we assess," said Robert B. Santulli, M.D., associate professor of psychiatry at the Geisel School of Medicine at Dartmouth.

Modifications to the model by Washington University (DUO, Dementia Understanding Opportunity) include a reduced time requirement to two hours per month and a modified recruitment partnership focusing on students with general geriatric interest, in lieu of neurology students. The DUO Program is midway through its pilot year and has recruited 40 percent more student participants than anticipated with a wait list for interested persons with dementia. In addition to the quantitative measures implemented from the Buddy Program, participant feedback and monthly reflections continue to provide rich data for future qualitative analysis. Several themes for further analysis, such as whether DUO's fewer partner hours can provide the same benefit as the longer hourly requirements of the existing Buddy-inspired programs, have already been identified.

According to the Alzheimer's Association 2013 Alzheimer's Disease Facts and Figures report, more than 5 million Americans are living with Alzheimer's disease. By 2050, the number of people with Alzheimer's could be as much as three times that amount. Yet too many people with Alzheimer's disease are undiagnosed — by some estimates, as many as 50 percent. Alzheimer's disease is the sixth-leading cause of death in the United States and is the only leading cause of death without a way to prevent, cure or even slow its progression.

About AAIC

The Alzheimer's Association International Conference (AAIC) is the world's largest conference of its kind. AAIC brings together researchers from around the world to report and discuss groundbreaking research and issues surrounding the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Alzheimer's Association's research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.

About the Alzheimer's Association

The Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's disease care, support and research. Our mission is to eliminate Alzheimer's through the advancement of research; provide and enhance care and support for all affected; and reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. Visit www.alz.org or call 800.272.3900.

SOURCE Alzheimer's Association