June 24, 2019
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From Bangor to Bangalore: Maine nurse shares aging expertise in India

When Amy Cotton received an email four years ago that would eventually alter the course of her medical career, she thought it was a scam. The emails kept coming, written in broken English by a man in India whom Cotton, a Bangor nurse practitioner specializing in aging, had never met.

Cotton ignored the emails, but the man persisted. He wanted her to help remedy a lack of expertise in his country about caring for older adults by partnering with his Bangalore nonprofit organization called AdvantAGE Seniors. Growing curious, she researched the organization, which had contacted 300 other geriatric specialists across the United States. Cotton was the only one to respond.

“It was three years before I got on a plane and went over there, wondering if someone would be there to pick me up at the Bangalore Airport,” she said.

In March, Cotton returned from her second trip to India, a country home to the world’s second-largest population but lacking many of the health care resources available to seniors in the U.S., such as assisted living and nursing homes.

“Their population of older adults is almost more than the entire U.S. population, and they have no infrastructure,” said Cotton, also director of operations and senior services quality at Eastern Maine Healthcare Systems. “The workforce isn’t well prepared.”

The country has a few aged-care facilities, but most seniors are looked after by family at home, she said. Government programs like Medicare and Social Security are nonexistent, leaving families to pay out of pocket, Cotton said.

Agencies including AdvantAGE Seniors work to help the community better care for older adults, explained founder Roshan Jacob, the man who emailed Cotton in 2010 seeking her help.

“But as the years pass, the need is increasing and we need lots of professionals,” he wrote in an email. “And Amy is one such person who is committed to the cause of the elderly and in the future with her help we can do a lot in terms of aged care. I am indebted to her for sparing a lot of time with me and helping the new venture of AdvantAGE Seniors.”

His organization funded Cotton’s trips, while she donated her time. Jacob also has launched an initiative to establish some gerontology courses to familiarize health care professionals with the field, he wrote.

Many nurses provide high-quality care and are willing to learn how to better care for seniors, Cotton and her colleagues learned after surveying more than 600 nursing students at several Indian universities. But they’re often equipped with little to no knowledge about the special needs of older citizens, such as preventing and treating bedsores, she said.

Working with 2,000 students in various health professions at seminars throughout southern India, Cotton shared her expertise about how diseases present differently in older adults. She serves on a panel of experts who advise Jacobs and his organization.

But she also has learned a thing or two, she said.

Many Indians face “tremendous challenges” with basic needs, such as access to clean water, Cotton said. While the American health care system emphasizes planning for end-of-life decisions, Indians she spoke with stressed their belief in taking all steps possible to sustain the life of an older loved one, she said.

“I think the biggest thing that I’ve learned is here in the United States we welcome people from so many different cultures, but we have a one-size-fits-all approach to health care,” Cotton said.

One of the biggest dangers in geriatric care is assuming everyone ages the same way, responding to medications and illnesses in predictable patterns, she said. Cotton returned from India inspired to remind other health providers, through both her academic interactions and clinical practice, that each individual patient’s preferences should guide their care, she said.

“We have a system that doesn’t make it easy for a person to talk about what they would want, know what their preferences are, and have care delivered in ways that are amenable to them,” Cotton said.

She witnessed unexpected similarities between the rural state of Maine and India, a country with a population of more than 1.2 billion: old and inadequate housing stock, difficulty accessing food and health care in remote areas, and a pressing need to prepare the health workforce to meet the demands of its oldest residents, she said.

Cotton plans to return to India next spring, with hopes to spend more time in the country’s aged care homes.

“It isn’t just a Maine issue, it’s a global aging phenomena,” she said.


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