Enhancing care for older in-patients is an eye-opening education for McGill students
Hospital Elder Life Program keeps older adults active and stimulated
Paraskevi Dogantzi is hardly what you’d call an uncooperative patient. She has agreed to get out of bed on this cold, gray winter morning, sit in a chair and perform arm and hand exercises with Shibo Yu, who works in the JGH’s Hospital Elder Life Program (HELP).
But when Ms. Yu, a 19-year-old physiotherapy student at McGill University, suggests that they continue with some type of recreation, such as a game, a puzzle or drawing a picture, Ms. Dogantzi seems to lapse into indifference.
All of Ms. Yu’s firm but friendly suggestions are declined. No, Ms. Dogantzi says listlessly, there’s nothing she feels like doing.
Quickly scanning the hospital room for clues about the patient’s personality and interests, Ms. Yu spots something on the bed, barely visible within the blanket’s rumpled folds: a ball of red yarn.
“Ah, I see you have some knitting,” says Ms. Yu, as she brings out the yarn, along with a knitted square and the needles that go with it.
Suddenly, Ms. Dogantzi perks up and her eyes widen. “Oh, my knitting,” she says happily, as she places the ball in her lap, accepts the needles and starts clicking away.
“What are you making?” Ms. Yu asks.
“Oh, nothing special.”
“Really? It looks like you’re starting a scarf. How did you learn to do this?”
“I just taught myself,” Ms. Dogantzi replies with a smile.
“That’s amazing,” says Ms. Yu. “And you work so fast! How long will it take you to finish?”
“Three days,” she answers proudly. “I can make a scarf in three days!”
Physical and emotional stimulation
And that, in a nutshell, is why the JGH has been so keen on developing and maintaining the HELP program. Its volunteers—plus this year’s group of 85 physiotherapy and occupational therapy students from McGill—are keeping older hospitalized patients active and stimulated to complement their hospital care.
Not only do the patients benefit physically, intellectually and emotionally from this personal attention, but the McGill students gain valuable hands-on experience at an earlier point in their education than is generally the case for students in their fields.
As is evident in the half-hour session with Ms. Dogantzi, the students are also learning to improvise and to adjust to rapidly changing circumstances.
They do so by becoming acutely aware of the needs and interests of their patients—all despite an age gap of 60 years or more.
Sometimes the students get lucky when a patient is in good humour and is ready with a quick comeback line. That’s what happens when Pesach Bosis is visited by Julia Lampasona, a 20-year-old McGill student in occupational therapy.
HELP wins McGill award
The Hospital Elder Life Program has received the Faculty Award for Teaching Innovation from McGill University’s Faculty of Medicine and Health Sciences. The program is the result of a partnership between the JGH and McGill’s School of Physical and Occupational Therapy.
In a letter to HELP’s organizers in January, Annette Majnemer, the Faculty’s Vice-Dean of Education, praised “the impactful and innovative contributions you are making to teaching, learning and education.
“You were chosen to receive this award this year, based on the nature of your innovation (originality, sustainability) and the impact on learners (replicability, number and range of learners impacted). We are deeply grateful for the work you are doing to advance education in our faculty.”
Responding to patients’ moods
Like Ms. Dogantzi, Mr. Bosis isn’t too keen on doing much more than exercising while sitting in a chair. However, in his case, it’s because he’s too excited to think about anything but his wife’s arrival at any minute. “She’s my treasure for 56 years!” he declares.
“Well then, maybe you’d like to draw her picture,” Ms. Lampasona suggests.
“Oh, no, I couldn’t,” Mr. Bosis insists with a sly smile. “She is too beautiful to draw.”
As might be expected, some patients also have their more sombre moments, which can overtake them without warning. For instance, during a visit with Phyllis Francis, whose right ankle and calf are in a cast, Ms. Lampasona compliments the patient on her distinctive ring.
“Thank you,” Ms. Francis replies and then abruptly bursts into tears. Between sobs, she explains that the ring had belonged to her mother, who gave it to her as a gift when Ms. Francis was just 17. “She wanted to see me enjoying it while she was still alive and I’ve never taken it off in all these years.”
“What a lovely thing for her to do, but it’s no reason to be sad,” Ms. Lampasona says gently. “It means you can have a good memory of your mother every day.”
“Yes,” Ms. Francis sighs, “I guess that’s true.”
“And look on the bright side,” continues Ms. Lampasona, smoothly changing direction to keep Ms. Francis focused on the positive. “Today is a happy day for you! The cast is coming off your leg.”
“Yes, that’s right, you’re right!” says Ms. Francis, breaking out in a smile once again.
Moments like these are a daily occurrence, as older patients “receive reassurance that someone cares about them and is concerned about their well-being,” says Aisha Khan, who helps supervise the HELP program and is a Professional Practice Advisor in the Directorate of Rehabilitation and Multidisciplinary Services.
“The students bring joy and a great deal of hope, especially to patients who may be experiencing psychological distress or depression,” adds Isabelle Lamontagne, an elder life specialist and HELP’s Coordinator. “The patients are reminded that life can be good and that there are many things they’re capable of doing.”
Preventing deterioration during hospitalization
The focus is on older patients, because they’re often in vulnerable condition and have multiple medical problems, plus special needs, explains Ms. Khan. Just the fact that they are hospitalized has placed them at greater risk for deterioration in their mental functioning, nutritional status and mobility.
HELP tries to minimize this decline by having trained individuals (including the McGill students) regularly engage the patients in a variety of revitalizing activities. These include light physical exercise and cognitive stimulation (playing memory games or working on puzzles), as well as assistance with meals and other everyday tasks.
Although this is the third year that McGill students are participating in HELP, it’s the first time a full January-to-April term is being conducted face to face. In 2020, the students were on duty in person in January and February, but they had to discontinue their JGH visits in March, when the first wave of the COVID‑19 pandemic struck.
Last year, since the students were not allowed into the the hospital, the entire term was completed via telehealth. Thinking creatively, members of staff developed Tele-HELP: Students performed the exercises at home on a virtual platform, while patients in the hospital (accompanied by a member of the HELP team) viewed the students on a tablet and did the same exercises.
As well as benefiting the patients, HELP gives the McGill students “a better understanding of what it’s really like to work with older adults,” says Gina Mills, Interim Assistant to the Director of Rehabilitation and Multidisciplinary Services, and Coordinator of Professional Practice.
“It also helps them develop a stronger sense of what will be expected of them and how they’ll eventually function as professionals,” Ms. Mills explains.
Preparing the students
To prepare for their hospital visits, the students received classroom instruction last fall. This included lectures—on such topics as ageism and communicating with older adults—from a team of interdisciplinary professionals, including members of HELP, a dietitian, a physiotherapist and a speech language pathologist.
To familiarize themselves with the hospital setting, the students also paid a preliminary visit to the hospital, where they absorbed numerous details, including how to adjust the position of a bed, and where to find the patient’s call bell.
Afterward, they received a training a video, prepared by HELP’s professionals, to which they could refer if they had any questions.
Ms. Lampasona calls the transition from classroom studies to working with patients “a drastic change, but it’s such an advantage for us. In most other programs, you do all of your studying before you go into the field, but we have this incredible opportunity to experience it in our first year.”
A little goes a long way
The support of the JGH Foundation, the JGH Auxiliary and individual donors is essential in enabling the Hospital Elder Life Program to provide its much-needed services. Thanks to these generous donations, HELP is improving care for elderly patients in a hospital setting. To donate, please contact the JGH Foundation.
“You really need to learn how to adapt quickly to unexpected situations,” Ms. Yu adds. “At McGill, we had simulations with actors who played the role of patients, but working in a real setting is like being in another world. We need to quickly establish a relationship with each patient and be ready for anything.”
The age gap might seem vast, Ms. Lampasona says, but sometimes, “if a patient has grandchildren, I get the feeling they see me almost like a grandchild who wants to know more about their family and their culture.”
“And they have such extraordinary stories to tell,” Ms. Yu continues. “Of course, being in the hospital is far from an ideal situation for them, but that doesn’t mean they can’t smile and be happy. When we speak to each other, I can feel they’ve enjoyed life.”
Ms. Khan has witnessed these uplifting results first-hand. “Just today, I heard from a nurse who told one of the students, ‘Be careful, the patient’s not in a good mood and he might even swear at you.’
“So the student chatted calmly with the patient about something he might enjoy doing and a minute later, she came back with a deck of cards. When I looked in on them, they had been playing for 20 or 30 minutes, and the student later told me they had been smiling and laughing the whole time.”
What Ms. Lamontagne finds particularly gratifying is that HELP is exposing many students to the practicalities—and rewards—of working with older patients.
“We know that for most young professionals-to-be in health care, providing occupational therapy or physiotherapy to older adults is not usually their first choice,” she says. “Many of them would rather do something involving children or sports or the arts—something a little more sexy.
“That’s why it’s so nice to see some of the HELP students really thinking differently about this aspect of their career. Spending time with the elderly brings its own kind of fulfilment and I’m glad that HELP can be part of that.”