A leap toward empathy: Transforming OT education with geriatric simulation

Sabina Khan and Jacqueline Achon, Volume 29 • Issue 10 • October 2024, pp. 12-17 10/01/2024

In the dynamic and ever-evolving landscape of health care education, the limitations of traditional classroom learning in fully preparing students for the nuanced and complex realities of patient care have become increasingly apparent (Lewis et al., 2024). In response, simulation-based learning has emerged as a vital, innovative approach, merging theoretical knowledge with practical experience. This method not only offers students a safe environment to engage with a variety of professional scenarios, but also bridges the gap between academic learning and real-world application. Among the various simulation methods available, geriatric simulation is notably distinct for its ability to immerse students in the physical and sensory challenges often faced by older adults. This shift from passive to active learning deeply engages students in empathetic exploration of geriatric care (Giner Perot et al., 2020).

OT students donning the simulation equipment.

At The University of St. Augustine Miami campus, geriatric simulation has become a fundamental element of our occupational therapy education program, profoundly altering our students’ perspectives on aging and patient care. As part of a research study conducted in January 2024, this lab activity exemplifies the transformative power of simulation-based learning in occupational therapy, providing students with a direct experience of the challenges associated with aging. More than a classroom activity, this lab encourages deep engagement with the conditions older adults face, fostering an immediate and profound empathy that traditional learning methods cannot achieve. Through this innovative educational strategy, students gain invaluable insights into the everyday realities of older adults, enhancing their preparation for professional practice in geriatric care.

An OT student bending to place a tray in the oven, using geriatric simulation equipment to understand the physical limitations and challenges faced by elderly individuals during meal preparation tasks

In our geriatric simulation lab, we use specialized equipment designed to authentically simulate the experience of aging, helping students understand the daily challenges encountered by older adults. For instance, weighted vests are utilized to demonstrate the effort required for simple movements when muscle strength is diminished—a common aspect of aging. This simulation brings to light why tasks that seem easy to many practitioners can be strenuous for some older individuals. Gloves are another key tool, designed to mimic the loss of tactile sensitivity and dexterity often experienced in older adulthood. Wearing these gloves, students experience firsthand the difficulty of performing daily tasks, such as manipulating household items or securing buttons on clothing—offering insight into the everyday frustrations encountered by older adults.

Vision impairment glasses play a crucial role as well, simulating common visual conditions like cataracts. Through these glasses, students experience the challenges of navigating their environment and performing tasks with blurred vision, increasing their understanding of and empathy for visual impairments common in older age. See Table 1 for equipment used and specific aging-related impairments each item simulates.

Table 1: Geriatric Simulation Equipment and Associated Aging Impairments

Equipment	Simulated Aging Impairment
Weight vest (20 lbs.)	Represents the general decrease in muscular strength and increased effort required for daily tasks.
Ankle weights (5 lbs. each)	Simulates reduced lower limb strength and mobility challenges.
Wrist weights (2.5 lbs. each)	Mimics diminished upper limb strength, affecting tasks requiring fine motor skills.
Knee and elbow restraints	Limits range of motion, representing joint stiffness and movement restrictions.
Gloves	Simulates decreased tactile sensation and fine motor difficulties.
Cervical collar	Limits neck mobility, reflecting common cervical spine issues in older adults.
Cataract vision impairment glasses	Replicates visual impairments such as reduced clarity and sensitivity to glare.
Ear plugs	Simulates the experience of age-related hearing loss, highlighting the communication barriers and increased effort in auditory processing common in older adults.
Walker	Provides experience with mobility aids, reflecting dependence on assistive devices for walking or standing (Zhai et al., 2023).

Students then proceed to a series of activities that bring these simulations to life. Table 2 outlines these activities, ranging from bed mobility and transfers to meal preparation—each intentionally developed to cast light on changes in function during the typical aging experience.

An OT student practicing household management tasks using geriatric simulation equipment.

Table 2: Simulation Activities and Simulated Impairments

Activity	Task Description	Simulated Impairment
Bed mobility and transfer to commode	Tasks such as getting in and out of bed and transferring to a commode, focusing on the complexities older adults encounter daily.	Functional mobility challenges highlight the effort required in basic movements. The use of knee and elbow restraints, along with the weight vest, simulates joint stiffness and reduced muscle strength, affecting the ease of moving and transferring.
Lower body dressing	The act of dressing oneself with added physical limitations.	Beyond coordination and strength difficulties, sensory impairments from gloves make it hard to manipulate fastenings like buttons or zippers and to pull the waistband on pants down or up.
Meal preparation	Preparing a meal under sensory and physical limitations.	The impact of tactile, visual, and fine motor impairments is compounded by difficulty in grasping utensils tightly or feeling textures of food. Vision impairment glasses add a layer of challenge in measuring ingredients correctly and reading recipes.
Functional mobility	Moving around with added weight and mobility restrictions.	Challenges extend beyond decreased strength and balance to include the difficulty of navigating spaces without the full range of motion, made harder by knee restraints and wrist weights, simulating the energy and effort many older adults expend in mobility.
Laundry	Completing laundry tasks, highlighting the effort and adaptation needed.	The combination of physical exertion and sensory limitations impact routine chores. Gloves and vision impairment glasses make sorting colors, reading care labels, and manipulating small detergent bottles or fabric softener sheets especially challenging.

Through engaging in these scenarios, students confront firsthand the combined effects of physical and sensory challenges, providing them with crucial insights into the necessity of patience, creativity, and personalized care in occupational therapy. The activities detailed in Table 2 offer students a hands-on chance to traverse the complexities associated with aging. These practical exercises serve as a bridge, translating the simulated impairments into real-world challenges that older adults face daily. It is a journey that not only educates but also transforms, fostering a deepened empathy and a nuanced understanding of the integral role occupational therapy practitioners (OTPs) play in enhancing the quality of life for older adults.

OT students engaging in bed mobility and functional transfers using geriatric simulation equipment to practice patient handling techniques.

Integrating geriatric simulation into the occupational therapy curriculum enriches students’ educational experiences by blending experiential learning with their academic studies. After participating in the simulation, students are encouraged to complete a worksheet rating the difficulty of various tasks, noting their observations. This reflective exercise is crucial for bridging theoretical knowledge with real-world application, facilitating discussions about age-related impairments and the importance of empathy in clinical practice. Table 3 outlines a sample geriatric simulation reflection worksheet.

OT students participating in a wheelchair mobility exercise, navigating through a hallway to better understand accessibility challenges and improve their skills in assisting wheelchair users.

Table 3: Sample Geriatric Simulation Reflection Worksheet

Task	Rating of Difficulty (0 to 4)	Observation (Student’s Reflection)
Functional Transfers and Mobility
Stand up and sit down on a chair	0 1 2 3 4
Transfer from bed to bedside commode	0 1 2 3 4
Navigate up and down a flight of stairs	0 1 2 3 4
Meal Prep & Kitchen Tasks
Pour a glass of water from a pitcher	0 1 2 3 4
Retrieve an item from a refrigerator	0 1 2 3 4
Heat food in a microwave	0 1 2 3 4
Complete a simple meal prep task (e.g., make a sandwich)	0 1 2 3 4
Dressing & Personal Care
Button a shirt	0 1 2 3 4
Tie your shoes	0 1 2 3 4
Put on a jacket	0 1 2 3 4
Medication Management & Finances
Open a pill bottle	0 1 2 3 4
Read a medication label and its directions	0 1 2 3 4
Pick up and count five coins	0 1 2 3 4
Mobility & Accessibility
Walk up and down stairs	0 1 2 3 4
Open a door	0 1 2 3 4
Communication & Leisure
Sign your name with a pen	0 1 2 3 4
Use a cell phone	0 1 2 3 4
Read a newspaper	0 1 2 3 4

Instructions for students: Complete each task while wearing the Geriatric Simulator. For each task, circle the number that best describes the level of difficulty you experienced (0 being no difficulty, 4 being very difficult). After completing the tasks, reflect on your experience and jot down any observations about how your body felt or responded during the activity. These observations can include any challenges you faced, how the task might feel for an older adult, or how the experience has impacted your understanding of geriatric care.

This worksheet example serves as a foundation for subsequent classroom discussions, where students share their experiences and reflections. Facilitated by faculty, these discussions aim to deepen students’ insights into the physiological and psychological aspects of aging, fostering a comprehensive understanding that will inform their approach to care in their future occupational therapy practice.

Undergoing the geriatric simulation marks a significant turning point for students. The reflective feedback collected post-simulation, as discussed in focus groups, highlights this transformative experience. Students share profound revelations about the physical and emotional challenges of aging, indicating a marked shift towards a more empathetic and comprehensive approach to care.

Conclusion

The impact of this immersive educational experience extends beyond the simulation lab, fostering critical skills in interactive clinical reasoning that are essential for person-centered and strengths-based geriatric care. By emphasizing the resilience and capabilities of older adults, the geriatric simulation encourages students to engage in thoughtful problem-solving and empathetic, individualized care. This approach not only bridges academic learning with practical, hands-on experience but also prepares future OTPs to address the diverse needs of an aging population with respect, competence, and a commitment to enhancing quality of life through personalized, innovative care.

References

Giner Perot, J., Jarzebowski, W., Lafuente-Lafuente, C., Crozet, C., & Belmin, J. (2020). Aging-simulation experience: Impact on health professionals' social representations. BMC geriatrics, 20(1), 1–7. https://doi.org/10.1186/s12877-019-1409-3

Lewis, K. O., Popov, V., & Fatima, S. S. (2024). From static web to metaverse:

reinventing medical education in the post-pandemic era. Annals of Medicine, 56(1), 1–20. https://doi.org/10.1080/07853890.2024.2305694

Zhai, M., Huang, Y., Zhou, S., Jin, Y., Feng, J., Pei, C., & Wen, L. (2023). Effects of

age-related changes in trunk and lower limb range of motion on gait. BMC musculoskeletal disorders, 24(1), 1–9. https://doi.org/10.1186/s12891-023-06301-4

Sabina Khan, PhD, OTD, MS, OTR/L, is an Assistant Professor at the University of St. Augustine for Health Sciences in Miami, FL. With more than a decade of clinical experience, she specializes as a certified women's health and pelvic floor specialist, and holds certifications in trauma-informed approaches. Her research in academia encompasses women's health conditions, trauma-informed care, and innovative health care education methodologies.

Jacqueline Achon, OTD, MS, OTR/L, is a Clinical Instructor at the University of St. Augustine for Health Sciences in Miami, FL. She has been an occupational therapist for 10 years, specializing in adult and geriatric care and focusing on neuro rehabilitation, fall prevention, and aging in place. Certified in stroke rehabilitation and fall prevention, she works closely with clients with conditions such as brain injury, stroke, and spinal cord injuries.