'Food for thought' in devising aging-simulation experience.

Abstract

Aging simulation (experiencing age-related functional decline), an educational tool commonly used in geriatrics education, is widely recognised for being able to drive positive attitudinal change toward older patient care. However, scholars1 warned that, given its focus on age-related limitations and disabilities, the method may lead junior medical students to take age-related barriers as impending and irrevocable, thereby reinforcing myths and negative assumptions on ‘growing old’. Prior research reported that, in aging simulation, interest in geriatric care (driven by empathy) might be achieved at the expense of worsening self-views on personal aging. To mitigate this unintended-side effect, a recommendation made was to integrate learning strategies of ‘demystifying myths’ and ‘experiencing aging’. Dysphagia is a health condition common in old age and often associated with malnutrition, pneumonia and dehydration. It can also be part of normal aging, given how the aetiologies also grow with age. Internationally, prevalence of dysphagia in aged care facilities has been estimated to be up to 40%. Yet, awareness and recognition of its impacts on one's lived experience are lacking among medical officers. While other age-related physiological changes such as walking difficulties, visual and hearing impairments are often covered in traditional aging simulation, dysphagia remains an unaddressed topic. In collaboration with a Hong Kong-based social enterpirse “The Project Futurus”, we piloted a 2.5-hour aging simulation workshop centred around dysphagia in old age. At a teaching kitchen, second-year MBBS students could personally relate to the mealtime experience of dysphagic older persons. The activity was part of a Medical Humanities Curriculum at HKU. Quota was capped at 20 owing to COVID restrictions. Instead of a focus on age-related difficulties and feelings of frustrations that usually characterize traditional aging simulation, our workshop, titled ‘Dignified meal and sparks for life’, exposes students to the realities of aging while shedding a positive light on wellbeing in old age: Before class, students were invited to experience food similar to porridge being served to dysphagic patients in the past. In class, students received (i) a mini-lecture demystifying dysphagia diet, and (ii) a live demonstration on using Japanese Engay (easy-to-swallow) cooking techniques to create more uplifting dysphagia diet with aesthetic appeal and texture. Then, students (iii) worked in groups to prepare and mould texture-modified meals, followed by (iv) tasting and debriefing on how the lived experience of dysphagic older persons could be transformed through person-centred care. We administered the validated UCLA Geriatrics Attitudes Scale (UCLA-GAS) to assess student attitudes toward older patient care, and Reactions to Ageing Questionnaire (RAQ) to assess attitudes toward personal aging. All participants (n = 20) completed pre- and post-questionnaires. Mean age was 19.5. Contrary to an earlier study,1 our workshop had improved attitudes toward geriatric patient care (p = 0.02) and personal aging (p = 0.042) in second-year undergraduate medical students. Cohen's d was 0.492 and 0.406, respectively, indicating moderate effect size in both measures. Despite a small sample, we have developed a new form of aging simulation pertaining to the human experience of dysphagia in old age. By integrating elements of ‘demystifying myths’ and re-orienting the activity's focal point from age-related difficulties to enablers of wellbeing, our pilot throws light on how aging simulation's unintended negative side-effect could be avoided.