Virtual Town Halls Educate Geriatric Patients During COVID-19

In response to widespread social isolation created by COVID-19 stay-at-home orders, and as part of an ongoing plan to adapt care during the pandemic, the Geriatric Medicine Senior Health Clinic at Massachusetts General Hospital has created a program of virtual town halls for geriatric patients and families.

Subscribe to the latest updates from Geriatrics & Palliative Care Advances in Motion

Thank you for subscribing!

Error: Please enter a valid email address.

Email Address Submit

Stay-at-home orders resulting from the COVID-19 pandemic effectively ceased in-person ambulatory care, in-home assistance and visits with loved ones for older patients. Knowing that prolonged periods of social isolation and lack of formal and informal supports can leave frail older adults susceptible to decline, outreach phone calls to patients and families revealed fear of the unknown and a lack of accurate information about the coronavirus, suggesting a medical knowledge concern. Mass General experts created the one-hour Zoom webinars to deliver the latest information about the coronavirus, general guidelines for staying healthy and safe, and to combat stress.

"Recognizing that we care for the most vulnerable people in the outpatient world, we knew we needed to adapt our primary care practice quickly," says Matthew Russell, MD, medical director of the Senior Health Clinic. His team that created and executed the the Virtual Town Halls included Susan Edgman-Levitan, PA-C, executive director of the John D. Stoeckle Center for Primary Care Innovation at Mass General, Judy Willett, project manager, and Monique Chateauneuf, executive assistant.

Objectives of the Virtual Town Halls for Geriatric Patients

The team wants patients to be able to see their doctors, even on the screen, and assure them that the clinic is open and available.

"We also wanted to create an interactive program that capitalizes on the brain trust at Mass General to provide the most up-to-date, accurate information about the virus," Dr. Russell says. Additionally, providing a sense of community is essential to combat functional and cognitive decline.

Specific goals of the virtual town halls are to:

• Provide timely information on recommended precautions
• Increase the number of patients and community members with an identified medical decision maker (health care proxy) with whom they have shared their wishes
• Communicate how Mass General practices provide safe, in-person care and why it is important to come in for needed care
• Explain how to access virtual care
• Describe what to expect in case of hospitalization
• Create a virtual community for geriatric patients, connecting them to clinicians and practice staff at each phase of the outbreak

Best Practices for Virtual Town Halls During COVID-19 and Beyond

"The virtual town halls were relatively easy to roll out and replicate," says Dr. Russell. The team's Virtual Town Hall Guide provides how-to information and Dr. Russell offers several best practices for health care systems wishing to execute similar efforts, including:

• Recruit the best presenters and coach appropriately: The best presenters are experts who share evidence-based content in plain language that older adults can understand. When speaking about COVID-19, infectious disease specialists need to present. Dr. Russell also notes that the ease and convenience of the virtual format enhance speaker recruitment
• Be flexible with topics and programming: "Our programs are contextualized geriatrics, speaking to whatever is going on at the moment in our country," say Dr. Russell. "Initially, our focus was the virus and its effects, then information about how to stay safe." For example, when it became apparent that some patients were afraid to go to the hospital, even for serious conditions, programming quickly pivoted to letting them know Mass General was open and what they could expect. Additional topics of interest for older adults have included voter safety, music therapy, virtual memory cafes and coping through reading and writing. Special guests have included Boston Mayor Marty Walsh and cellist Yo-Yo Ma
• Include a question-and-answer component: "Giving patients the chance to ask questions of the experts, either in the Zoom chat function or submitted ahead of time, has been important," says Dr. Russell
• Create a sense of community: An unanticipated spin-off from the Virtual Town Halls was a small, biweekly Zoom support group led by Dr. Russell and a social worker. "It's a lovely group of patients who are not depressed because that is a different kind of support," he says. "Participants are older adults who, for the first time in their lives, are experiencing extreme isolation." They can ask medical questions, discuss the news and often exchange creative ideas for coping
• Record the event and replay on your hospital's website: Extend the reach of speakers' messages by archiving the presentations for future use

Outcomes of Virtual Town Halls

The Senior Health Clinic team is collecting and analyzing data about the virtual town halls' impact, but anecdotal feedback has been strong from practice clinicians whose patients attend the events. MassGeneral for Children has also adopted the model and the Virtual Town Hall Guide is being used by health care organizations nationwide.

Dr. Russell adds that every speaker has loved being a part of the effort. "One of our presenters, Don Berwick, MD, MPP, of the Institute for Healthcare Improvement, commented, 'This is the democratization of medical knowledge.'"

The Virtual Town Halls highlight the importance of accessible technology for virtual care of older adults. Dr. Russell calls on governments and philanthropists to make communication technology widely available.

"It's important for patients to become 21st-century tech-savvy because it's no longer a pastime but a lifeline," he says. "Online communication is a way for us to stay connected to our family, health care providers and education. It also allows us to receive cognitively stimulating activities as opposed to enduring this time of total isolation with just a passive experience of television or radio."

View all COVID-19 updates

Learn more about Palliative Care and Geriatric Medicine