As we approach the one-year anniversary of the COVID-19 pandemic, the burden of the novel coronavirus in the United States is a well-documented and still unfolding story. Tens of millions of infections. Hundreds of thousands of deaths. Strained intensive care units. Long-term medical challenges faced by many disease survivors.
But the pandemic has also exacted a heavy, if less visible, toll on millions of others who have thus far avoided infection. These are vulnerable elderly forced into isolation, many for months on end, to protect themselves from the virus. The price of escaping illness can be heavy: loss of contact with family and friends and the chance to form new and sustaining memories that are vital to a sense of purpose, meaning and well-being. Social isolation is also linked to a host of health problems in the elderly, including depression, cognitive decline, and cardiovascular issues.
The difficulties aren’t surprising. The pandemic did not suddenly isolate older people; rather, it exacerbated an existing problem, said Jodi Waterhouse, program manager with the Multidisciplinary Center on Aging at the University of Colorado Anschutz Medical Campus. The center, founded in 1993, works to improve the health of older adults through research, clinical care, education and community engagement.
“Loneliness and isolation are not new to the older community,” Waterhouse said. “That was happening before COVID-19. But COVID has raised the intensity exponentially.”
If opportunities for many older people to connect with others were slim before the pandemic because of transportation challenges, geographic separation, physical issues and other barriers, COVID-19 “closed the door” even further, Waterhouse said.
Students step up to help ease social isolation for older adults
But there are opportunities to open that door, as evidenced by a collaborative initiative between the University of Colorado Anschutz Multidisciplinary Center on Aging, the CU schools of Pharmacy, Nursing and Medicine, the Seniors Clinic at UCHealth University of Colorado Hospital on the Anschutz Medical Campus and community partners around the state.
The program is dubbed COAST-IT (Connecting Older Adults to Students through Inter-professional Telecare). The idea is that students from the schools (currently around 160) regularly contact an elderly “partner” through a phone call or Zoom meeting – not to discuss medical issues but rather to have an old-fashioned, open-ended conversation that sparks a personal connection.
The program also aims to benefit the students, said Dr. Sarah Tietz, assistant professor in the Division of Geriatric Medicine at the CU School of Medicine and project lead for COAST-IT. She noted that the COVID-19 surge that began last March short-circuited students’ clinical rotations at UCH and other hospitals – and their ability to interact with patients in general.
“Students across campus who were usually coming into the hospital and getting to know patients had a lot of these opportunities taken away because of COVID,” Tietz said.
With so many older patients anxious about being told to isolate and worrying about losing contact with their medical providers, the Seniors Clinic called on students to make phone calls to patients to check on their medication needs, fall risks, mental health status and other issues, which the students then reported to clinic geriatricians.
Older adults as teachers for medical students
That work led Tietz, Waterhouse and others to the realization that regardless of COVID-19, students simply don’t get many chances throughout their training to interact with older patients and learn about them from a broader perspective than a routine health care encounter. The COAST-IT program thus pivoted to having students reach out to older adults in facilities – nursing homes, assisted living facilities, retirement homes and so on – across the state with conversational check-in calls.
“We thought that we had a great opportunity for students to get to know older adults and understand some of the unique troubles they face and also have an opportunity for our older adult partners to have someone they can interact with regularly,” Tietz said. “Hopefully, we can help to prevent social isolation and mental health disorders along the way.”
That approach makes sense now and for the future, Waterhouse added. She noted that the number and overall share of Coloradans 65 years and older is expected to sharply increase over the next three decades. In fact, the state reports that since 2000, the 65-and-up population has increased at a much faster rate than the overall population of the state. In other words, any practice students get interacting with older patients today will serve them well tomorrow.
“Students will be better able to hone their communications skills and better understand the thinking and actions of older adults,” Waterhouse said. “We’re an aging country. It’s unfair for students to graduate not having been exposed to that experience.”
Tietz added that she and her colleagues hope that the program encourages more students to go into fields working with older patients. This would help plug a shortage of health professionals who work in geriatrics, she said.
Medical students learn the power of listening
The students receive a handbook with overall guidelines for the project, including preparing for, making and documenting their calls. They are then paired with an older partner, with whom they work – with the help of facility staff – to forge a telehealth relationship, Tietz said. In addition, students have monthly Zoom calls that cover a variety of topics, such as recognizing and addressing cognitive impairment and depression. They also talk about issues they’ve encountered in the calls – how to respond to sensitive issues, like grief, for example.
Tietz said that a key goal of COAST-IT is to help students learn to engage their partners through “active listening,” rather than to dispense knowledge and guidance to a captive audience.
“Oftentimes, when you listen to someone, you are not solving a problem, but rather bearing witness to what they are going through,” she said. “That in and of itself can be really powerful.”
The calls also offer students a way to learn “valuable lessons that are not commonly taught in medical training, and not what you get in a 20-minute clinic visit,” Tietz noted.
“Older adults have a lot to offer society, but they may not feel they are able to contribute or are valued as much,” she said. “Students can really learn a lot from them – about their life experiences, the challenges they have navigating the health care system, what it is like living in a nursing facility, and the common struggles that go along with that.”
Medical students tune in on what’s important
Kelly Hannon, a second-year student in the CU College of Nursing’s Adult-Gerontology Primary Care Nurse Practitioner program, began calls to her older adult partner in the fall. Hannon said her partner is “well adjusted” with “a great attitude” despite the long-term isolation she’s had from her family.
“I get as much out of the phone calls as she does. It’s a two-way street,” Hannon said. “I’ve learned so much about her generation and how she grew up. The elderly are fascinating. They have been through so much and seen so much change. Getting that perspective helps to ground you.”
Hannon added that the conversations have reinforced the point that good patient care consists of more than medical training.
“The biggest thing I’ve learned is to just be silent and listen,” she said. “Older adults want someone to talk to. Just having someone be quiet and listen to them is often really what they need. I think that talking to someone for 30 minutes a week would help make seniors’ lives happier.”
The puzzle of human connection
Ruth Olson, a first-year pharmacy student, has a less talkative partner – one that she describes as “an endearing, sweet, grumpy guy.” Early on, she “felt like I was intruding in his life” with her phone calls. But that’s hardly discouraged her.
“The amount that he talks depends on the day,” Olson said. “He’s not a chatty kind of guy, but that that’s him and who he is. It has nothing to do with me.”
Olson said making a connection with someone she met “quite literally blind” wasn’t easy at first. “It’s like a difficult puzzle to put together,” she said. To kick-start conversations, she asked questions about where her partner grew up, what he did for work, how his retirement was going and so on. She didn’t let his silences bother her. On the contrary, she’s learned from the challenges.
“The (COAST-IT) program has helped me to step back and work on my communication skills,” Olson said. “I try to slow down and make sure I’m speaking clearly so we have a real conversation where both of us are participating.”
If her partner doesn’t want to talk, she added, “I don’t take it personally. I will just be there and have an open mind about it. I genuinely care about him and am vested in his well-being.”
And she sees him taking at least one small step away from his isolation: joining a Bingo game at his assisted living facility.
“I don’t know if it has to do with me, but I like to think so,” Olson said. “He hadn’t gone to Bingo before, but then he went, so that’s exciting.”
Expansion plans for a program that helps with older adult isolation
The COAST-IT program is slated to expand in the coming months, with some 25 students from the Nurse Practitioner programs and another 40 from the School of Dentistry joining, Tietz said. The end of the COVID-19 pandemic remains a question mark, but even if it were to magically end tomorrow, she and her colleagues plan to keep the outreach to older adults in place.
“Social isolation is not a new problem with COVID-19, it’s just a bigger problem,” Tietz said. “We hope to continue COAST-IT after COVID.”
Waterhouse said the current effort has spawned an outreach network that stretches across the state of Colorado. Starting this semester, the calls now include older adults residing in independent living facilities as well as in their homes in the community.
“We want to give joy, purpose and attention to older adults,” she said. “We’re providing a light in a dark tunnel, and that will continue after COVID.”