So, med student, how does it feel to be old?

CHAPEL HILL -- Older patients in hospitals and nursing homes have often been treated with disrespect, stripped of their identities and wrongly diagnosed.

As part of efforts to discourage such treatment, medical students at UNC-Chapel Hill recently got their own taste of how it feels to be old.

In a role-playing exercise this week, students were handed cards detailing fictional identities as older patients, then quickly subjected to a hasty, callous string of procedures.

"We can teach people in multiple ways -- giving a lecture about caring is, in my mind, not the best way to underline that issue," said Dr. Jan Busby-Whitehead, chief of the division of geriatric medicine at UNC-CH.

"The best way is to put someone in someone else's shoes."

Clamor filled a crowded classroom at UNC as residents and others playing "bosses" subjected students playing older patients to a series of indignities: commands to wear adult diapers and nicknames such as "Muffin" and "Sweetheart," with no serious attention to patients' concerns.

"I was frustrated to the point of death, which is what might happen in a real situation," said Allison Serra, a second-year student from Durham.

Providers nationwide are working to improve care for an oncoming wave of older patients, for both ethical and business reasons. Starting this week, Medicare, the federal insurance program for people over 65, will no longer pay doctors and hospitals for medical care that results from preventable errors.

"There is a perfect rationale behind that," said Dr. Hal Atkinson, program director for the geriatrics fellowship at Wake Forest University Baptist Medical Center.

Medicare wants to make sure hospitals that make fewer mistakes receive financial benefit, Atkinson said. "Certainly we could be doing better than we are now," he said.

At Wake Forest, about 75 percent of medical students spend time with geriatric patients during their third year, but the university wants to increase that to include all students.

"It's difficult from a societal perspective because there are so many negative images of older people that students get exposed to," Atkinson said.

Simulations illustrating the difficulties of older patients have been around for decades, Busby-Whitehead said. But given increasing numbers of older patients, the exercise is now mandatory for all incoming internal-medicine interns at UNC and is being extended to many other hospital staffers.

Faced with the prospect of amputations, forced restraints, shouted questions to deaf patients and other horrors, the UNC students seemed to get the picture quickly.

Second-year student Kira Peoples, 23, of Murfreesboro was given the role of a 60-year-old patient who mistakenly took a double dose of diuretics. She was labeled a "biter." Then, just after Peoples was put in an adult diaper, she drew the game's last card.

"I died! I got really dehydrated," Peoples said a few minutes later, pulling off the white sheet that marked her death.

"They made assumptions about me, and they didn't believe what I said."