Interprofessional students bridge across disciplines to learn how to care for people with dementia

Author: Annie M. Geiger is a second-year medical student at The University of Massachusetts Chan Medical School.

On October 24th, I joined a team of medical students, physician assistant students, and pharmacy residents associated with UMass Chan Medical School, Bay Path University, and Baystate Medical Center to begin a two-week Population and Community Health Clerkship at Armbrook Village, an assisted living facility in Westfield, MA. The focus of the clerkship was to learn about the delivery of care to people with dementia at Armbrook Village and the needs of this population of older adults. However, as the clerkship began, the value of teamwork in this field became increasingly clear as we learned how interdisciplinary the care team at Armbrook Village is. The interprofessional nature of our own team was a small reflection of this.

As a medical student, I have limited opportunities to work with students and residents from other healthcare professions. Having an interdisciplinary clerkship team enhanced every person’s learning, as we all later reflected on. I admired the PA student’s careful approach and clear expertise with working one-on-one with residents from prior experience. The perspective of a pharmacy resident on medication regulations within the assisted living setting was valuable, as these facilities are not allowed to split, crush, or administer medications. Through understanding these restrictions, she said that she would be more mindful about ensuring that her patients who might be in assisted living facilities receive their medication in forms they could self-administer. Her pharmacological perspective was especially useful in the field of care for older adults because polypharmacy can be a great challenge, as well as in the area of medication to treat dementia, with the recent approval of controversial drugs like aducanumab. From learning about regulations surrounding dosing medication to restrictions on lifting residents, our team now better understands when an individual would need to transition from an assisted living facility to a nursing home and what factors would lead them to choose one facility over another.

There is an incredible diversity of roles of care team members for residents in the memory care unit. Before this clerkship, I had not previously met a recreational therapist; the Armbrook Village recreational therapist is responsible for designing multiple daily evidence-based programs and activities for the residents of the memory care unit to engage in. We joined in on these activities and helped facilitate them during much of our clerkship time. Some of the sessions included dance sessions, yoga, and stretching for strength building and fall prevention. It was clear that these activities bring joy and purpose to the resident’s lives.

It was also valuable to learn from the residential care assistants (RCAs) to understand their daily work. The RCAs know individual residents better than any other member of the care team and provide critical information to the other team members that can guide care plans. For example, they provide information about the frequency, intensity, and duration of new behaviors that is necessary for the psychiatric mental health nurse practitioner to know when considering medication efficacy and side effects. The RCAs shared that they strive to maintain a calm atmosphere and regular structure for the residents, because this has been demonstrated to be ideal for most people with dementia. They put great effort into maintaining this structure through regular communication amongst the care team and de-escalating situations when necessary. After this clerkship, I now better appreciate the emotional and physical challenges faced daily by RCAs, and I recognize the value and heart that they bring to the care team.

In my time at Armbrook Village, I was surprised to learn about the variety of care team members for people with dementia, from recreational therapists to case managers to psychiatric mental health nurse practitioners. It was valuable to observe how they all worked together to provide optimal care for patients. This makes me feel hopeful that residents of this memory care unit and other similar facilities are receiving the attention that will help them feel comfortable and lead lives of purpose. In the absence of quality treatments to cure dementia, perhaps the most helpful thing we can do as current and future healthcare providers is to make individuals living with this disease feel cared for.