My time in Brazil has reminded me of my deep interest in medicine and becoming a future physician. I had the opportunity to shadow several doctors and follow doctors in their residency program and ask them questions. I was so impressed by the collaboration and community being built at FMUSP as it reminded me of my time at Davidson. SP is a very special place and the people here are paving the path to creating more humane and caring future physicians at Las Hospitals De Las Clínicas São Paulo. Below you will find my observations and ideas as I conversed with people who worked in various settings that support older adults. The municipality also has spearheaded multiple initiatives that support older adults. However, this information was not as easily accessible since they do not have a strong social media presence or advertising. They can be found in this link.

Hospital Setting:

I was given access to the Geriatric Unit during my time in SP. I am impressed by the multiple initiatives that are being spearheaded by the hospital to improve the well-being of older adults with the Geriatric Day Hospital and Geriatric Sexuality Clinic, etc. This has given me a glimpse of what it means to be in a hospital and provide care beyond being sick but establishing areas where we can do more preventative work and develop social programs.

Gerosaude/GAMIA (PROPES Program)

• Created by  Dr. Wilson Jacob Filho. It was a pleasure to meet him in-person during my first week in Brazil. His colleagues continue to support these programs and help run it smoothly. This program is where older adults are sewing something together or do an activity. They are in community and meeting new people.

Geriatric Sexuality Clinic – Dr. Milton Cretine

Every Friday, the Hospital offers a geriatric sexuality clinic. I was very impressed by this as this tends to be a taboo topic when we bring in older adults. I arrived very early, at 8:30 am, where I got lost but eventually made my way to the area. During my visit, I met Dr. Milton Creatine, who runs the clinic, and Dr. Fernando, a fellow. I was so intrigued by how they discussed sexual health with their patients and together normally. In today’s society, people find discomfort or do not engage in these types of conversations, especially for older adults. We need to keep continuing to have these types of conversations in order to improve the sexual well-being of all older adults and not allow for society or other factors hinder it. 

I started my day off shadowing Dr. Fernando and then hearing the debriefing from with Dr. Milton. The safe environment that Dr. Fernando created and seeing what else had to be done. I was also intrigued by how he tried to address several of the person’s needs. For me what was the most impactful interaction was when I asked an ethical question and dr. Milton emphasized as a physician, one must protect the well-being of an individual and support them. I was deeply fascinated by this idea as at times it is difficult to separate one’s personal views from their professional views. 

I was further touched by the open thinking of how we are able to best address the needs of a patient in order to best protect them. How can we as physicians, be sure that we are providing unbiased information in order for our patients to make the best types of decisions? Additionally, how can we ensure LTCFs are creating safe spaces for this? It was interesting after reading the Last Taboo and some of the case studies on how they handled that. I recently went to an LTCF in Santos and was amazed by this one couple who had to be separated based on their living conditions. His wife eventually passed, but he was able to find another love three more times. They were simply holding hands and for me this is so crucial how we can use physical touch.   

At the end of my visit Dr. Milton recommends some research articles along with other information to look into as I progress through my time. I was deeply intrigued by the ideas proposed and the information as they made me dive deeper into the work of LTCFs and what they can do in order to respect one’s identity. We must continue to keep growing and learning as well as adapting to the changing demographic of our aging population. What we thought worked years ago does not necessarily neatly apply to today’s time. Other models of care being done and implemented. 

I am eternally grateful for getting this understanding and exposure at this point of my journey to be able to ask more questions during my time in Germany. I look forward to learning from their diversity statements and all that has to be done in order to improve the wellbeing of older adults. What does it mean to be able to live a life of dignity and calmness? How can we continue to create such spaces for varying costs? Are you doing any changes.

Severe Dementia Unit – Dr. Linian Molina

Every Monday the hospital has a severe dementia unit that is run by Dr. Lilian Mollino. 

I spent two days with her and learned more. I had the opportunity to meet a group of fellows and caregivers on the second day. To start, I was there early in the morning to participate in the severe dementia unit rotation. I was shadowing one resident and observed how they talked to the patient and family. The fellow was very holistic and then another set of doctors came in to talk to the family and patient. I was shocked to see how various doctors from different departments spoke to the patient in order to provide a holistic treatment plan. The family seemed content with the services that their mother was receiving by the various professionals. In a way, we have to think about how we can do this in order to better support family members. 

The next day we had a caregiver group meeting where two fellows led a workshop. The workshop I attended was on caregiver tips for people with dementia. I was deeply inspired by the presentation as I wished I knew some of this information when caring for my mother and grandmother. They were very creative and were helping these older adults be better caregivers. They created a space to learn and see what is or is not working.  

Together these experiences at the hospital reminded me of how we are able to make these spaces as well more accessible and age-friendly. We have to start and create these spaces. 

Geriatric Day Hospital –

We need to create more spaces where older adults are able to be attended and treated promptly for minor care needs. Their vision is to “Be an effective option in the institutional process of “dehospitalization”, generating strategies and disseminating this form of action in an environment favorable to assistance, teaching and research.”

Long-Term Care Facilities:

The following section will have my reflections from the LTCFs that I was able to visit in person or virtually. Below I will then summarize my main takeaways. It was a privilege to learn from you all and see the model of care you all are providing.

Hospital Geriatrico e de Convalescentes Dom Pedro II

Here is my reflection (click on the link).

Residencial Club Leger

Reflection: After visiting The Hogeweyk four years ago I was impressed with what it meant to have a deinstitutional model of care. Today, I am impressed by the biodiversity that this facility created for its older adults. They have a playhouse for children, a tennis court, a swimming pool, and an area for the gatherings of family events. Additionally, they allow for family members to stay the night and accompany their loved one. These spaces they created encourage family visits and not only that but brings a smile to older adults to engage with family members. I was so impressed as well by the staff that they had. This man danced with this someone who uses a wheelchair and it was the most eye-opening and inspiring dance I’ve ever seen. As he lifted his leg, the lady too tried lifting her leg. This creativity is what it means to age with dignity. I also was inspired by the doctor who gave a speech on Women’s Health and reminded them that they can be open about their emotions. This was the first time I’ve actually seen this being told to older adults and see the trust that is being cultivated. At times older adults do not feel empowered to let their emotions or ideas be heard as it has been stigmatized in the past yet this doctor is breaking those chains and reminding them that they are valid and will be heard. This touched me beyond words as this empowerment will improve the quality of life these older adults face. Additionally, after this presentation, the adults had another session with the psychologist and it was another inspiring talk. The psychologists gifted everyone a rose and the had to say what it means to them to be cared and everyone had an array of ideas. At the end they collected the roses and said together we will grow and watch these roses grow. This activity for me touched me as its building community amongst these people and uniting them to fight the emotions of isolation and depression that plagues our elder community.

Here is the link for my more detailed reflection

Residencial Tamandare

Reflection: I am beyond grateful for this facility allowing me to visit as I simply emailed them, and they were eager to have me visit. This is the first facility where I did not speak the language, but we managed. They transformed a home into a home for several older adults. I loved how one will not know this is a place where older adults are living as the exterior is a house. Edelcio Tabboni, the Founder of Tamandare, was very kind and told me how he became passionate about creating a space for older adults due to working with a geriatrician and his wife being a nurse. He wanted to his facility to look like a home because it is the home for older adults and wanted to stray away from the institutional model. This was a unique place as everyone who was independent or semi-indepdent were grouped together in one floor and then another floor for more dependent residents were placed.

Link to video: https://fb.watch/grzF6tFuCZ/

Casa Ondina Lobo

Reflection: This facility is located in the middle of a residential area in SP. I was deeply impressed by this place as it is the first philanthropic facility I came across. They had a very large space and an open model of care. They rely heavily on private companies to help fund certain projects or provide resources. The facility had a bazaar or store where people could purchase things that the residents and/or community members donated in order to get funds. They also had a library where older adults were able to take a book and read. The healthcare system that Brazil has SUS allows for several medications to be provided free for all older adults. They also partner with educational institutions such as FMUSP to have geriatric fellows volunteer there. I appreciated that they collaborate with educational institutions in order to create more humane and care physicians. On top of that, in order to help with staff shortages and be able to provide better care. This facility reminded me of the importance of having a volunteer group and how families around the neighborhood help the facility with certain holidays, projects, and events they have going on and their children. This unique facility has a cooking class that helps older adults learn to cook with children. This intergenerational workshop is important as several older adults love this and is different from the general activities LTCFs provide. Additionally, they provided two residents a private space for them to work as one is a painter and another a craftsman.

Link to reflection: https://www.ondinalobo.org.br/

Cora Residencial para Idosos

Reflection: Cora Residencial is a facility where they offer more hotel style settings. Pending Update

Residencial Israelita Albert Einstein

• Postponed visit due to COVID-19 restrictions. You can view the video:

Terca da Serra

Reflection: This LTCF is a franchise model. They have over 100 facilities all throughout Brazil. Pending Update

Casa Del Sol

Reflection: An incredible facility that is mixed private and public. They have an ample amount of space that can be better utilized.

Day Center Visits: Pending Update

Associação São Joaquim

Reflection: https://www.instagram.com/reel/ClOgr3ssyC-/?igshid=YmMyMTA2M2Y=

Pending Update

Main Takeaways:

• Governments must have an action plan for LTCFs to follow and hold them accountable. We need to think about QUALITY over QUANTITY.
• Municipalities and/or NGOs must use social media for advertising services for older persons in order to capture a larger audience of older adults and caregivers
• We must reevaluate inclusivity and diversity statements within LTCFs
• We must allow space for future doctors to learn how to care for older adults in multiple settings, from private to public or rural to urban.
• We must continue to think about how we can use cats/dogs as therapy within LTCFs or social robots. Perhaps, develop a governmental program where animals are used for therapy to be able to assist public care settings.
• Consider having a library within LTCFs for older adults to engage with and/or coloring books.
• We must consider having gardens in LTCFs for residents to interact with.
• We need to be intentional with the spaces we have in LTCFs and think about the design aspect. For example, what colors are we using? Are we associating certain colors with meals and activities?
• We need to have more conversation amongst public and private LTCFs to share resources on activities that work and do not work
• Think about community partners for LTCFs

Muito obrigrado a todos e todas! Hasta la proxima.

Thank you to all these professionals above and organizations. My deepest gratitude to you all and Dr. Marlon Aliberti. LinkedIn Post: https://www.linkedin.com/posts/luis-cordero-8185b9194_agingwithdignity-reimaginingcaresettings-activity-7005513854206013441-IcvB?utm_source=share&utm_medium=member_desktop

Resources:

Introduction to the diversity of LGBTI+ ageing Kindle Edition (Free E-Book)

ILPI Resource: https://frente-ilpi.com.br/