Geriatric Medicine Focus
CONJ 693, CONJ 694
Geriatrics Track Objectives:
Students will learn the importance of professional partnership necessary to deliver comprehensive care to elderly patients. Mastering skills of comprehensive assessment for frail, chronically ill, and medically complex elderly patients, students will become skilled at identifying medical and non-medical issues impacting an individual's level of function and identify areas necessary to optimize independence and positively impact quality of life.
Students will become familiar with the role community resources, rehabilitative care facilities and longterm care living situations play in assisting functionally dependent elderly and chronically ill individuals. Students will be encouraged to develop attitudes of respect, empathy and appreciation for limitations posed by physical, emotional, psychological and environmental barriers to independence. Students will learn that rather than seeking single answers to some of these questions, they will identify a multitude of solutions, often creative and always developed by teamwork.
Students will complete Chronic Care Geriatrics with an understanding for the limitations of therapeutic options based on unsupported evidence, age-related adverse outcomes, competing medical co-morbidity, medical futility and respect for patient autonomy. It is intended that students appreciate the constraints of caring for individuals at the end of their lives and the need to develop a more extensive partnership to facilitate care and address often unmet needs.
Geriatric Track Expectations and Goals:
To understand the complexity of geriatric issues, including medical, psychosocial, and economic factors that impact function and quality of life for elderly patients.
- Functional Assessment
- Develop skill in the clinical assessment of function including:
- Skills of Living: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
- Cognitive function: Mini Mental Status Examination (MMSE), or Montreal Cognitive Assessment (MoCA)
- Develop skills in assessing risk for and remediation of falls in the
Elderly: Up and Go Test, Falls Assessment.
- Appreciate the role and elements Comprehensive Geriatric Assessment (CGA) has in providing a functionally-based overview of geriatric care for select older individuals (including motor function, medical assessment, social and environmental assessment, cognitive and affective state assessments).
- Site-specific Goals of Care
- Appreciate common problems in the hospitalized elderly requiring special monitoring and rigorous assessment (including delirium, intra and post-operative coronary events, pain, polypharmacy, pulmonary complications due to immobility, and skin breakdown).
- Appreciate the role thoughtful planning has on post-hospital disposition. Develop a sense of the importance systems of communication between care providers has in safe transitions of care in the chronically ill.
- Become familiar with the various sites of care other than independent living available for functionally impaired individuals (including senior housing, assisted living, rehabilitation care, skilled nursing facilities and hospice care), understand the distinguishing features and principle funding for these alternative treatment/living/care options.
- Gain familiarity with caregiver responsibilities and the impact this has on an individual.
- The Multidisciplinary Care Team in Geriatric Care
- The student will become familiar with the multidisciplinary team in geriatric care, the participants and their role in comprehensive assessment, development of plan of care and disposition planning for hospitalized elderly.
- Home Visit
- Students will participate in at least one home care visit of an elderly patient. Students will appreciate how the home environment impacts quality of life, medical compliance and functional status. A written and oral presentation of this experience is required for successful completion of the course. Formatted questions will be provided to all students.
- Formal Didactics
- Students will attend all formal teaching conferences and lectures offered at their assigned clinical sites.
- Students will complete any reading assignments and examinations developed or this clerkship or assigned by the geriatric module coordinator.
- Students will gain knowledge in special topics in Geriatrics including:
- Urinary incontinence
- Biology of aging
- Economics of aging-mechanisms of financing care of older adults
- Functional dependence and options for levels of care
- Elder abuse
Educational Experiences and Expectations:
Students will work as a member of interdisciplinary care teams. Often working in conjunction with nurses, social worker, pharmacists, nutritionists, and therapists, students will participate in the comprehensive assessment of patients with a purpose of developing clinical goals given the care setting, and developing care plans that address the needs of the individual.
Students will observe a variety of living arrangements where individuals are provided with the level of personal care commensurate with their specific needs.
Students will participate in care delivered to those with life-limiting and terminal medical conditions. Students will appreciate the important role the care team plays in managing the end-of-life medical, psychological and spiritual needs of that individual and their family.
Students will make a home visit, ideally to the living situation of a patient that the student has previously worked with during their in-patient stay, but if not, the student will identify the elements of personal care and degree of assistance an individual requires to live within their community. For some, this environment may be a nursing home, for others it may be an adult family home, or their own dwelling where they may live alone or with a number of caregivers.