Janice Giard has a lot to look forward to. In the next few months, the 75-year-old Burlington, Vt., resident anticipates gathering with friends, attending a family wedding and playing with her great-grandchild. She knows that maintaining good health will allow her to enjoy these activities, and so she tries to exercise daily and eat vegetables.

“I feel good. I lost weight and lowered my blood pressure, and I’m enjoying my life,” Giard said during a recent Medicare annual wellness examination with nurses Jason Garbarino and Kristin Luce G '22 at Appletree Bay Primary Care, UVM’s nurse-practitioner-led practice. The hour-long checkup took place with Giard fully clothed, in a chair, talking about herself. The nurses asked Giard about her living situation, sleep habits, exercise routine, social supports, hobbies, mood, medications and alcohol use. They discussed social determinants of health, including Giard’s ability to pay for food, rent and fuel. The nurses checked Giard’s recall abilities and addressed her concerns about staying mentally sharp.

Giard’s wellness exam focused on personalized preventative care, with screenings for cognitive decline, depression and fall risk along with discussions about personal goals, what matters to them in their lives and their health care preferences. During the past year, Appletree Bay shaped Medicare annual wellness exams to join a nationwide effort to provide “age-friendly health care” that addresses what matters to patients and how that aligns with their medications, mental activity and mobility.

“Talking with a patient about what matters to them guides the discussion and care,” said Garbarino, a clinical associate professor at UVM and practicing registered nurse (RN). Dr. Garbarino serves as a nurse faculty liaison with the Dartmouth Centers for Health and Aging Geriatric Workforce Enhancement Program. The program focuses on partnering with primary care sites across the country to implement and test best methods for primary care delivery to older adults.

Providing “age friendly” exams for older people earned Appletree Bay status as a Level 2: Age Friendly Health System-Committed to Care Excellence from the Institute for Healthcare Improvement. The practice is the first health care system in Vermont to achieve this designation, given to clinical care settings that provide and document specific, evidence-based best practice interventions to older adults. The goal of the recognition program is to encourage culturally competent care, improve health outcomes for older people, reduce waste associated with unneeded or unwanted services and increase patient satisfaction.

While he works with patients at Appletree Bay, Dr. Garbarino mentors undergraduate nursing students and RNs pursuing a Master of Science – Clinical Nurse Leader (CNL) degree at UVM.

“These visits provide an opportunity for patients to express their thoughts, feelings and goals pertaining to their health,” said Hannah Scheibner ’21, an RN at Appletree Bay. Shadowing Dr. Garbarino’s wellness visits with older patients as an undergraduate nursing student bolstered Scheibner’s interest in pursuing primary care. “I became a nurse to help people, and seeing how nurses work in primary care to keep patients healthy and live with the highest quality of life epitomized these goals.”

Nan Orhsan, 80, made jokes and told stories of her life during her wellness visit with Garbarino and Luce. She talked about her sons who live out of state, neighbors at her senior housing residence and her experiences as a child and young adult. She asked about sleep medications and expressed concern over recent bouts of vertigo, wondering if she should get her ears checked. During the cognitive assessment with Luce, Orshan laughed as she drew a clock with the hands showing ten minutes until 2:00.

“It’s nice to see patients coming in to check their overall heath,” said Luce, who, as an RN pursuing a CNL degree, had done all of her previous clinical work in an inpatient hospital setting. Asking healthy patients about what matters to them about their health as they age “is a cool concept,” Luce said. “It turns the health care focus to what they want to do, not what we want them to do.”

For Janice Giard, staying engaged in her health care has personal benefits.

“I enjoy playing with my great-granddaughter. We laugh and giggle. I’m looking forward to playing with more great-grandchildren,” Giard said. “It makes it so I don’t have my mind on myself. That makes me happy.”