Last week, Chris Langston asked readers to assist us with our future grantmaking and strategic plan (Help Us Spend $100,000,000!). He requested input to help us define the nature of the problem in improving the health of older adults. I hope we get responses not only from seasoned health care leaders, but also from new health professionals just entering the field (in addition to feedback from other sectors and the general public).

I know one group we can certainly learn from--MSTAR Scholars. Participants in the Medical Student Training in Aging Research program take the summer between their first and second year of medical school to conduct mentored research and receive clinical training in geriatrics. I was fortunate to hear several fantastic scientific presentations from MSTAR students in the New York area at the end of the summer (see photo). For those of you not as lucky, you can still “meet” many of these students by reading their own words online. Many of them recorded and posted their experiences in the lab, classroom and clinic in the blog Diary of an MSTAR Student. This remarkable collection gives us insight into issues facing older adults from the trainee perspective and a glimpse into the future where these soon-to-be physicians will help us find the solutions we need to improve care for older patients.

In one diary entry, we meet Sharon Ostfeld-Johns from the University of Rochester School of Medicine, who is helping develop a tool that would improve the predictive validity of the widely used Charlson comorbidity instrument. She shares her excitement at realizing the importance of her research project, while pinpointing a pressing concern for geriatricians in increasingly measurement-focused environments. She describes an exchange between a geriatrician and another physician on recently implemented electronic health records in a hospital:

“Apparently, an expensive diagnostic test was required according to the electronic system if a certain set of criteria were entered in a patient’s record. The geriatrician argued that often, in his patient population – older, frail, with multiple comorbid diseases – the results of the diagnostic test would not result in a change in his management of their problems, and therefore, he wanted additional options that would allow him to use his clinical judgment and not be cited for “failing” to provide required care . . . I realized in the clinical office a perfect application for the comorbidity tool that had been to me, until that moment, only a spreadsheet full of data.”

Michelle Barlow at Mount Sinai optimistically reflects on her work to improve pain management of older adults in the emergency department, where providing good geriatric care often proves difficult:

“There are simply too many patients and not enough time to really be able to address the multifactorial concerns of a geriatric patient. Perhaps this is why EM physicians struggle to adequately care for their older patients. It can be a harsh environment for everyone involved, but it doesn’t have to be. One step at a time, we can improve the system.”

These students can already identify some of the biggest gaps in clinical care, research, and education that we need to fill in order to improve the health of older adults. Even more impressive is their own understanding of what it will take for them to provide quality, patient-centered care throughout their careers. You can see the blossoming of an excellent practitioner when reading a post from University of Cincinnati student Rosemary C. Bailey-Pridham about a palliative care consult with a dying older patient and her sons (warning--find some tissues before reading):

“I was surprised to find myself looking out the window for any distraction that could keep my eyes from tearing up. I scolded myself for thinking of my own mother, 30 years in the future with me at her bedside, and prayed that I would have the strength to carry out her wishes and give her dignity in death the way these sons were doing for their mother. How do you say goodbye to your mother?" READ MORE . . .

Throughout their diaries, most of the MSTAR students also express the appreciation for older adults they’ve gained through the program, an appreciation that needs to be spread among all health professionals:

“These patients have so much wisdom to offer, so much life to share. It’s a privilege to take care of them.” - Sydney Harvey, University of North Texas Health Sciences Center at Fort Worth

“It was in that moment that I realized geriatrics is not just taking care of “old people.” It is caring for a vulnerable population that was once you and I.” - Maria D. Brown, The Ohio State University College of Medicine

“Why geriatrics? Well that’s easy — the patients are entertaining!” - Suvi Neukam, University of New England

These MSTAR students are not only terrific spokespeople today, helping others realize the rewards of working with older adults. They also represent our hopes for the future as clinicians, educators, and researchers changing medicine for the better. Since 1994, the John A. Hartford Foundation has proudly funded the MSTAR program and outstanding medical students like Sharon, Michelle, Rosemary, and the others you’ve met here. The program is administered by the American Federation for Aging Research, in partnership with the National Institute on Aging and other private funders like the MetLife Foundation. As we at Hartford look forward to new grantmaking and strategic planning, we will also look back to our network of funded health professionals, including all of our MSTAR students, for input and guidance on how to best allocate our resources and improve the health of older adults.