"Aging in Stride" a Perfect Companion to Senior Group Visits

?by Joyce Remy, Senior Editor

Many physicians today report frustration with the sliver of time allowed for each patient: the average visit lasts around 10 minutes. Family physicians, who often chose the specialty so as to be able to treat patients as individuals, instead find that they have no time for the in-depth wellness focus they know is so important.

To address these concerns, and to streamline the delivery of quality care, the concept of group visits has developed over the last decade. During group visits, a number of patients with similar medical needs (such as diabetes, heart disease, obesity, depression) can be seen in unison. Background information and general self-care instructions are given to all at once, thereby eliminating redundancy while allowing for a much longer appointment lasting about 90 minutes.

The group visit model is ideal for many seniors. One or two doctors can cover common issues in depth. Routine medical checks blood pressure, weight, diabetes checks take place within an environment that more resembles a seminar or support group than it does the standard individual medical appointment. A series of studies show that that seniors who participate in regularly scheduled group visits...

• are more likely to follow the care regimen prescribed
• report greater satisfaction with their healthcare provider
• have fewer hospitalizations and emergency room visits
• report a greater sense of trust in their provider.

At Group Health Cooperative in Seattle, WA, family practitioners Dr. Sallie Dacie and Dr. Karin Madwed hold group visits once a month. Approximately 25 older adult patients come together in a conference room for routine checks, and a presentation and discussion on a monthly healthcare topic relevant to seniors, such as diabetes, depression, advance directives, incontinence or exercise. The group visit format is empowering to seniors, who are encouraged to participate in the discussion, and to feel ownership by helping plan subsequent sessions. Dr. Dacie reports, "Seniors adore these visits! And peer pressure is powerful. If I tell one patient to cut back on salt, and she admits to the person next to her that she hasn't, she may get a motivating pep talk and some ideas." Patients reinforce wellness information through sharing experiences and information."

Not all the learning takes place during the appointment. As a "textbook" for the group, Dr. Dacey chose Aging in Stride. One of the book's three authors is Dr. Christine Himes, Director of Geriatrics at Group Health, and Aging in Stride very much mirrors the philosophy of empowerment found in the class.

In preparation for each monthly visit, group members read a relevant section of Aging in Stride. Dr. Dacey says, "The book is a wonderful resource! It's positive and upbeat, but it covers the issues in a realistic manner." She adds, "Since the book is modular, we can select the chapter or section that is pertinent, in whatever order we choose."

For example, during the October group visit, the focus was advance directives. The doctors assigned "Issue 24: Informed Consent and Advance Directives" and had patients complete "Form 24: Personal Values Statement." By the day of the appointment, patients already had a good background and were armed with questions for the group discussion.

Dr. Dacey reports that Aging in Stride also serves as a "syllabus" for the group. Members leaf through the clearly organized issue sections to suggest future topics. The book is "senior-friendly," with plenty of visual cues and large print. It is comprehensive enough to be appropriate for a diverse group of seniors, regardless of age and health status.

Healthcare organizations that hold group visits report one more benefit: the socialization and increased social network among members. As Aging in Stride stresses, staying connected is an important component of successful aging. Group visits provide something that is not available when patients are waiting alone on that examination table: friendship!