reprinted from Issue 18, Spring 2014 of Frontiers of Medicine (PDF)
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Wen you are working with frail, community nonprofit," he says. "They older adults, you gain an have a tremendous amount of agility understanding of the law of unintended consequences," says geriatrician Erwin Tan, MD. He directs Senior Corps, part of the federal Cor- poration for National and Community Service, which connects volunteers age 55 and older with service opportunities. "If you add a new medication, you have to look for new drug interactions. Now as a policymaker, I have to be aware that any time I create a new policy or regulation, there can also be unintended consequences."
Tan (pronounced "Tawn") completed his primary care internal medicine residency at San Francisco General Hospital (SFGH), then trained at the San Francisco Veterans Affairs Medical Center as a geriatrician and VA National Quality Scholars Fellow. He served on the SFGH faculty for two years before becoming a White House Fellow, then joined the Johns Hopkins faculty. He was a co-investigator of the Baltimore Experience Corps Study, a randomized controlled trial of the health benefits of participation in a volunteer program that places adults 60 and older in Baltimore City public schools as AmeriCorps members.
During residency, Tan was impressed by geriatrics’ team approach to the whole patient. He remembers observing a team meeting during his first day of training at On Lok, a community organization serving seniors. "The bus drivers’ supervisor said, ‘Ms. So-and- So was a little slow on the steps the other day,’" he recalls. "The nurse said, ‘Bring her on in.’ It was remarkable that everyone’s opinion counted at the table – including the bus driver’s."
Tan’s training at UCSF helped him learn how to evaluate diagnostic tests, facilitate difficult conversations with patients and their families, and use national data sets like the Health and Retirement Study as a comparison group when conducting research about seniors. During fellowship training, he also joined the board of Conard House, an organization serving people with mental illness. "It was extremely valuable to understand the needs, restrictions and stakeholders of a community nonprofit," he says. "They have a tremendous amount of agility and community trust, but are often run on a shoestring budget."
Seniors as a Resource
Tan now applies his expertise as a geriatrician to his role as a federal grantmaker. Senior Corps has several programs connecting seniors with service opportunities ranging from tutoring children to assisting with national disaster recovery efforts. Senior Corps’ programs have about $200 million in federal investment, with some 1,200 Senior Corps grantees nationwide.
As some of Tan’s own research has suggested, volunteers often experience benefits themselves. "Sometimes school chairs are a little low, so seniors have to practice getting up from them, which strengthens their quadriceps," says Tan. "If you stumble, the quadri- ceps can prevent you from landing with a high impact. Mental activity may be helpful as well – and trying to teach a child to read is an all-consuming cognitive experience. Most importantly, there is evidence to suggest that social isolation as a chronic condition is an independent risk factor for death and poor health outcomes. But if you promise a child that you are going to be there, you are more likely to get up off the couch and go to school."
"Erwin has done amazing things," says Kenneth Covinsky, Edmund G. Brown, Sr. Distinguished Professor in Geriatrics. "He’s done a lot of traditional research, but is also leading this incredible national public service program. We often think of volunteering as a one-way street, but Erwin has been really innovative in evaluating how it can also help the volunteer – because social engagement is really important as you get older. We’re really excited and proud of his work."
Under Tan’s leadership, Senior Corps also instituted the first-ever competitive grant renewals for one of its programs, and created performance measures across the board. "As a physician, you learn the importance of data that you can trust," says Tan. "By 2030, one out of every five Americans will be age 65 or older, and I want Senior Corps to be an evidence-based program that is well-run and ready for expansion when the need arises. The Boomer generation represents the best-educated, healthiest population to cross over that traditional age of retirement. You’re talking about an immense amount of human capital that has the potential to be mobilized into community impact through national service."