No man is an island" is a well-1^1 known cliche that may be applied to many situations. In the health care of the aged each health professional may feel he/she is an island since there are many perplexing problems related to our older citizens. A multidiscipline approach would appear to be the ideal solution. An interdisciplinary effort implies respect and understanding of the unique contributions of each health team member in maintaining and preserving the health of the elderly. To be an effective health team member, one must be secure in his/her own discipline as well as have an understanding of the aging process.
It becomes the challenge of the educators in the various health colleges of The University of Iowa to assist students to gain an understanding of their role in the health care system that serves the aged. The educator in the colleges of the Health Science Division is in reality the role model for the student. The faculty of the various health colleges have developed simulated learning experiences that help students at The University of Iowa get the feel of what the older person experiences. For example, the College of Dentistry has a head gear of lenses and mirrors that distort the vision and when the student wears this device he/she must change his/her gait so he/she doesn't fall. This makes manifest that one cannot expect the older person to move about easily in the dental office.
The College of Nursing has developed various approaches such as having students patch one eye, crutch walk, and then attempt to carry out the expected social responsibilities such as eating with others and reading. The health science colleges have a wealth of films and slides depicting the stress of being an older person in today's society. Likewise each student in some of his/her planned practicum experiences has the opportunity to work with older clients. In the College of Nursing the students participate in Well Elderly Clinics' and make home visits to clients in the community with chronic health problems. Many clients of the university dental and medical clinics and hospital are over 60 years of age because of our Iowa population/ age distribution. Iowa boasts about the fact that 19.6 of its population is 60 years of age and over.2 The facilities are utilized for practicums by the several health colleges.
Not only does the student in a health science college need to be aware of the unique health care problems of the older person, but he/she needs to know also the uniqueness of each health professional role in the health care team that shares in the care of the aged. In the fall semester the College of Dentistry scheduled a one-day conference for seniors and practicing dentists. The goal of the day's program was to familiarize students with the aging process and selected health care problems from the perspective of the dentist as a member of an interdisciplinary health care team. The objectives were to:
1. Identify myths and stereotypes associated with aging.
2. Describe physiology of aging.
3. Analyze selected medical pathology associated with aging.
4. Describe psychological adjustment to aging.
5. Describe clinical dentistry for the geriatric patient.
6. Describe and evaluate practice management for the geriatric patient including: (a) office design, (b) scheduling, (c) treatment planning, (d) financing, and (e) dental staff coordination.
7. Identify community and total health care resources available to the geriatric patient including: (a) physician, (b) public health nurse, (c) pharmacist, (d) social worker, (e) religious institutions, and (f) public agencies.
It was decided that the planning committee itself should be a demonstration of an interdisciplinary health team in action. Representatives from the various health care areas (College of Medicine-Family Practice, Gerontology Center, College of Nursing, School of Social Work, Area Agency for Aging Office, and a Nursing Home) were invited to participate with the College of Dentistry and Department of Dental Hygiene in planning this one-day conference. One of the enjoyable and exciting features of such a large and varied planning committee was the excitement of the interchanges that occurred as members met and began to consider the multiple options for the program. It was decided that a keynote speaker was needed to set the tone of the day. This was to be followed by a panel and small group discussions. The dental students would be discussion leaders. The committee also decided that it would be more meaningful if there were presentations by a practicing dentist and dental hygienist who were specializing in the care of the geriatric patient.
Figure 1. Panel members are from left to right: Robert Rakel, MD; Geraldine Busse, RN, MPH; Dennis Helling, PhD, pharmacist; Thomas Walz, PhD, social worker; Jane Wright, RN; Kenneth Freedman, DDS; and Ronald Ettinger, DDS, is standing.
A date was selected that coincided with the sojourn of Sir Ferguson Anderson, MD, of Glasgow, Scotland, to the University of Iowa campus as the visiting professor, the recipient of the Ida Beam Distinguished Faculty Award. He is one of the pioneers in the field of geriatric medicine. His speech was titled "The Advantages of an Interdisciplinary Approach in Meeting the Health Care Needs of the Elderly." Following his presentation a panel discussed a scenario of a case history of an older man who lived alone and had numerous health and social problems. The panel consisted of: a physician, a professor of family practice, a public health nurse, a professor of nursing, a pharmacist, a professor of pharmacy, a social worker, a professor of social work, a dentist, a professor of dentistry, and a nurse administrator of a nursing home. These six persons were given copies of the scenario two weeks in advance and were asked to: (1) explain what their professional role would be in respect to the elderly man, and (2) what they would expect from the other professions represented on the panel. All persons in the audience had copies of the scenario and were encouraged to write out questions for particular panelists. Following the panel discussion, Sir Ferguson Anderson spoke to the scenario and to the panel's ideas.
Resource persons for the afternoon program were a dentist and a dental hygienist-Dr. Kenneth Freedman, a practicing dentist from Chicago and Professor Shermie Schafer, a professor of dental hygiene from Indianapolis. Following their presentations of about 45 minutes each, all students were divided into workshop groups of 12 each to work on solving problems of scenarios of elderly patients. The leaders for these groups were students who had been oriented and trained in group leadership techniques at a special evening workshop.
The morning session was open to all health professionals and the afternoon session was limited to dental students and dental practitioners.
All persons met in a large audi- torium for the morning presentations and for the lectures in the afternoon. The workshop discussion groups met in seminar rooms in the same building. Keeping the groups together for the entire day facilitated the discussions and enabled the conference to proceed on schedule.
Figure 2. Group of dental students in small discussion group.
There were displays depicting students working with elderly clients. Dr. Freedman brought his mobile dental van, the "Geriatric Tooth Fairy," and had his mobile dental equipment on display. The van was parked near the building entrance and the portable dental chair and support equipment were on display for students and others to actually use. This provided an extra attraction and demonstrated an innovative approach to health care for the elderly.
As one of the nurse members of the committee, I felt a dual responsibility to acquaint fellow health professionals with the role of the nurse both in hospital and community settings in the care of the aged, and secondly to share information about the needs of the older person as perceived by a professional nurse. The committee decided that we should be both specific and practical in our formal presentations. We had developed a scenario depicting a 76-year-old widower living alone in a small Iowa town with a limited income. He was found by his neighbor in a semicomatose condition and hospitalized. He was a known diabetic who had a cerebrovascular accident six months before.
In my presentation I described the nurse as the client's advocate and as a facilitator of the client's plans. The health care team could only begin to help this 76-year-old man if his goals and expectations were known to them. So upon his hospitalization, the nurse, through doing personal care such as giving insulin as prescribed by the physician, could learn how he managed this in his own home and how he planned for the future. Thus, by caring for his immediate needs, the nurse could begin to establish a trusting relationship. In this careful history taking and appraisal of his ability to manage his personal care such as bathing, shaving, and taking medications, the nurse could discuss with him those community resources that were available. Often in this kind of appraisal the nurse learns that the individuals have their own informal resource system such as neighbors and friends who provide transportation, grocery shopping, and the needed socialization. The nurse often becomes the liaison person helping the client utilize himself and the other resources in meeting his day-to-day needs. The nurse may aci as the referral agent to various health professionals and agencies and share this information with other team members by recording on the client's record or chart and by team conferences. The client should be included in the planning for his care. The nurse may be the facilitator in such a planning conference, as he/she is the one who has the opportunity to have the most time with the client and thus knows his most unique daily living needs.
Figure 3. Geraldine Busse conferring with dental hygiene students.
In order to acquaint the participants of the workshop with community nursing service, the functions of home health agencies and the activities of well elderly clinics were .discussed. For example, I described how one county public health nursing agency in Iowa has a "Foot Care Day" at its well elderly clinic. The clients may not only have foot inspections but may have assistance in care of their toe nails. This is a difficult chore when one's vision is limited and one is not as dexterous with a clipper as one would like to be.
The audience asked the panel specific questions about the suggested treatment of the older man described in the scenario. There was much interest in the availability of funds for the care of the elderly. It was emphasized that health professionals should participate in community health planning programs and that any plan for care of the elderly should involve the older citizens themselves. In the written student evaluation of the panel presentation it is to be noted that they saw the nurse as the client's advocate and a referral person, as well as giving specific nursing care measures.
In evaluating the day, the following conclusion was drawn. The level of participation by all was high for the students. Additional time could have been used for discussion by students about the data presented as well as more intensive exchanges among members of the various professions.
As a consequence of this conference, interest has remained high among many of the dental students, and some members of the interdisciplinary planning committee continue to work together on other projects regarding the aging. Specifically, teams of students have prepared inservice training packets on oral health care for nursing homes and have field tested them with nurses employed in nursing homes. Plans are in process to establish a mobile dental unit staffed by students that would serve nursing homes and the well elderly clinics. A continuing education day is planned for dentists who are dental consultants to nursing homes and the directors of nursing in nursing homes. The program is being designed to provide a common education experience and includes a structured exchange of expectations regarding oral care of the elderly. This will stimulate more inservice education programs for nursing personnel in the nursing homes. Finally, a curriculum review is under way in the dental college prompted by the hope of enlarging the gerontological content and increasing the input from the other health care disciplines of nursing, medicine, and pharmacy.
- 1. Crowell C, Freel M, Hart L: Developing assessment clinics for the elderly. J Gerontol Nurs 4(4):40-47, July-August 1978.
- 2. US Bureau of Census: Characteristics of Population-Iowa. Washington, DC, US Government Printing Office, February 1973, pt 17. table 21.
- 3. Leahy K, Cobb MM, Jones M: Community Health Nursing. New York, McGraw-Hill Book Company, 1977, pp 316-319.
- 4. Archer SE, Fleshman R: Community Health Nursing. North Scituate, Mass. Duxbury Press, 1975, pp 323-345.