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Noosha Afshin Jah's hands shake and her voice wavers as she arrives for her appointment. Her joints ache, she's uneasy on her feet and she relies on a cane for mobility and support. She's having trouble seeing clearly and tasks that were once easy for her – such as reading small print or getting in and out of a chair – have become significantly more difficult.
Luckily, the frailty she is experiencing is temporary. Noosha, an occupational therapist at Toronto Rehab's Musculoskeletal (MSK) and Multi-System Rehabilitation Program, is taking part in a simulation facilitated by The Michener Institute of Education at UHN that mimics the experience of becoming frail with age.
Noosha is wearing a bright orange jumpsuit – the frail aging simulation suit – equipped with straps, bands and weights that limit movement in her joints and force her to walk slowly and with a pronounced hunch. She wears goggles that limit her vision, earplugs that impair her hearing and gloves that reduce her sense of touch. All together, the suit simulates many of the physical characteristics associated with frailty.
The frail aging simulation suit is part of the "Working With Seniors" specialty program offered by The Michener Institute to help healthcare workers gain a better understanding of the healthcare needs of an aging population. The suit immerses its wearer into the experience of what simple activities might feel like for a frail older adult, helping to change participants' perspectives on providing senior-friendly care.
Every day, Noosha helps patients at
Toronto Rehab's MSK and Multi-System Rehab Program who have experienced traumatic injuries, significant fractures, or who are recovering after a joint replacement. The program focuses on self-care and regular daily activities to help patients regain their strength and independence after injury, aiming to safely prepare patients to return to their homes.
Sylvie Robinson, manager of the MSK program, estimates that more than half of their patients are elderly, arriving to the program after undergoing a total joint replacement or suffering from a fractured hip, knee or pelvis.
"A high percentage of the older patients are here because they fell," she says.
For many of these patients, their falls can be attributed to frailty associated with aging, or simply bad luck.
"Like tripping over a rug or a garden hose," Sylvie adds by way of example.
To gain a deeper understanding of what frail aging might feel like for many of their patients, Sylvie and Noosha stepped into the shoes of an older patient and participated in Michener's aging simulation.
'It is unbelievable how challenging it was'
The simulation begins with Noosha playing a frail, elderly patient, arriving to her doctor's office for an appointment. After walking down a short hallway, she is greeted by the receptionist, played by Sylvie. Following the simulation script, Sylvie asks Noosha to read out her health card number. Noosha, fully garbed in the simulation suit, lets out an audible sigh and fumbles with her cane as she reaches into her pocket to remove the health card from her wallet.
"Can you please read it for me?" Noosha asks repeatedly, struggling to decipher the small print on the card. Exasperated, she reads the numbers slowly as Sylvie repeats them back to her.
"It's better if you double check," Noosha says finally.
The simulation scenario is informed by lived experiences of seniors who contributed their voices to the development of Michener's Working With Seniors program. It's designed around experiences older adults often face in any given healthcare setting: busy waiting rooms; spaces that are not fully accessible; and staff and healthcare providers who may not fully understand the unique needs of older patients.
Throughout the simulation, Noosha is asked to walk between the reception desk and the waiting area no fewer than three times. Each time, she struggles to get to her feet, placing nearly all of her weight onto her cane.
"It is unbelievable how challenging it was," Noosha says during a debrief session after the simulation.
As an occupational therapist in the MSK program, Noosha is deeply familiar with many of the challenges older patients face, and with many of the emotions that her patients will experience while receiving care.
"They don't always want to tell you what challenges they have. They don't want to feel like they're not useful," she explains.
In the suit, Noosha admits that she felt the same way.
"It was embarrassing. You don't want to show people that you're not capable of doing something."
Noosha's experience in the suit isn't surprising, according to Audrey Gottlieb, Coordinator of Continuing Education New Programs, Markets and Partnerships at Michener, and facilitator of the aging simulation. She says that for many healthcare professionals, both in training and those who are established in their fields, putting on the frail aging simulation suit is an eye-opening experience.
"We had one physiotherapist who had been practicing in a geriatric organization for years," Audrey explains.
"After stepping into this suit, he realized that he should actually be giving patients instructions a lot differently. For example, breaking down tasks when asking patients to do certain things."
Working With Seniors
The Michener Institute's Working With Seniors program was introduced to Michener's full-time students in 2014 to address the emerging healthcare needs of the province's aging population. The program trains students to understand the unique needs of older adults, from understanding and adapting to patients' abilities and impairments, to responding with and demonstrating empathy.
"By stepping into the suit and experiencing some of the challenges that elderly patients sometimes face, it helps participants to better relate to and empathize with their patients," Audrey says.
The program supports healthcare professionals gain a better understanding of, and empathy for, the lived experience and needs of seniors in the healthcare system. Participants can choose from online modules and a range of different simulation exercises, including the frail aging simulation suit, to customize the offering for their setting and team.
"It would be great if everybody could have this experience," Noosha says of her experience in the aging simulation suit.
"I never thought it would be that hard."
Geriatric patients will soon make up 50 per cent of our patient population. Recognizing the critical importance of this learning across our health care system, Working With Seniors is now available as an online Continuing Education offering, designed for busy health care workers and teams.
Click here to learn more about registration.