Alfred is an older man with macular degeneration, hearing loss and some mild cognitive issues. He's celebrating his 74th birthday with his family, but they treat him more like a 7-year-old.
He spills his wine and thinks he hears his family say something about a doctor, but their voices are muffled. He turns his head to the side to get a full look at his daughter's face because the macular degeneration has caused a big, black circle in the center of his vision.
His mind wanders to a mountaintop where he picks flowers and throws them off the edge. Soon, he's at a doctor's office being evaluated.
Alfred is not the patient, however. He's a teacher.
"We are Alfred" is a pioneering virtual reality program where students don a headset to experience first-hand what it is like to be an older adult living with these common conditions.
Students at the University of New England College of Osteopathic Medicine in Maine - the state with the oldest population in the country - are among the first in the world to use this program as a means to learn empathy for their patients.
"We're trying to get our students to understand the person-to-person approach of caring for people and working with people," said Dr. Marilyn R. Gugliucci, professor and director of geriatrics education and research at the college. "We don't want to just teach in a classroom. They've got to know people to help heal people."
The students become Alfred for just over seven minutes, seeing the world through his nearly blind eyes and struggling to hear as the family sings "Happy Birthday." The way family members treat Alfred sticks with students, which they said they will remember when treating older patients.
"It really puts in perspective what the patient is going through, and you don't really understand it until you experience it," said Emily Szuba, a second-year medical student at UNE. "Emotionally, it was very difficult and even though you are only Alfred for a few minutes, he still really sticks."
Alfred is one piece of the intensive education in geriatrics each medical student must complete at UNE. In their first two years, these students spend 34 hours focused on geriatrics, nearly seven times what most medical schools require, Gugliucci said.
She said this type of immersive learning has never been more important. Each day, 15,000 Americans celebrate their 55th birthday and 10,000 celebrate their 65th. Nowhere is this aging trend more pronounced than here in northern New England, which is already home to the nation's oldest populations.
"Everybody should be focused on aging," she said.
Most graduates of this program go on to practice here in New England. Matthew Rocheleau, a second-year medical student at UNE and a 2016 graduate of St. Anselm College, plans to return to his native Rhode Island to practice. He said being Alfred allowed him to personally witness a "real-life and common medical condition" that will make him a better doctor.
"After using the virtual reality program, I hope it planted that seed in me to increase my awareness when working with these folks," Rocheleau said. "When it comes down to it, I truly believe that people want to be understood and listened to."Being Alfred
Virtual reality has been used in recent years for teaching surgery and other medical procedures, but this is the first time virtual reality is being used to teach a student what it's like to walk in their patients' shoes, said Gugliucci.
All first-year medical students are required to put on the headset and experience life with macular degeneration and hearing loss. Of the 250 students who have become Alfred, 92 percent reported increased empathy, 88 percent reported increased learning about macular degeneration, and 89 percent reported increased learning about hearing loss.
Rocheleau said the experience was surprisingly emotional, making him feel "alone and saddened."
"Others within the story were not aware of what I was going through, and I think that made me feel that sense of being alone," he said. "The interactions I had with the folks in the story were one-sided, people talked down to me and at me. I never felt part of the conversation."
Gugliucci said there is a new virtual reality program in development to demonstrate what it is like to live with dementia.
"If we can get people to understand what it's like to have dementia, that would be a major leap forward," Gugliucci said.
Szuba said she hopes to see more programs like these in the future.
"It would be really amazing if these programs continue to grow," she said. "It only takes a few minutes, but it is something you will never forget."Just one piece
For these students, their learning of the aging process and patients goes beyond wearing a headset and looking at a computer.
Students spend two days living in a hospice center, talking to the dying and sleeping in a bed where someone has died. Some spend two weeks living in a nursing home - including locked dementia units - being treated as if they are the patients. The school recruits 90 older Mainers to partner with 180 students to help them learn about the aging process.
"We are out in the community," Gugliucci said. "They connect heart-to-heart with the patients." This work has helped UNE earn the designation as an "age-friendly university" from the Association for Gerontology in Higher Education. The school was the fifth in the country and the first in northern New England to earn the prestigious title.
According to the school's 2017 report on where its graduates are practicing, 49 percent of their New Hampshire students return to the Granite State to practice, with 23 percent serving in rural areas and another 18 percent providing in underserved areas.
Gugliucci said she believes this intensive, immersive learning is what is going to help her students better treat the region's rapidly aging population.
"Health care and medical care are not the same," she said. "We're putting the emphasis on health."Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at email@example.com or (603) 206-7739. See more at www.unionleader.com/aging.