Geriatrics

Geriatric Service

Faculty:
Jane Potter, M.D. (Chief)
Stephen Bonasera, M.D.
Brenda Keller, M.D.
William Lyons, M.D.
Debra Mostek, M.D.
Edward Vandenberg, M.D.
Christy McAndrew RN, MSN,ARNP 
Sara Wolfson RN, MSN, ARNP

Duration: 1 month

Introduction:

Geriatric medicine is the prevention, diagnosis, care and treatment of illness and disability in older people. This approach of promoting the health of the older patient takes into account the interaction of diseases, medications, the environment, personal and social factors, and age. Geriatrics acknowledges the favorable and unfavorable elements of aging. However, it stresses that physical and mental deterioration are not inevitable consequences of the aging process, and that there are positive aspects to growing older.

Geriatric Service...House Officers:

Goal

  1. Continue to develop history and physical examination skills
  2. Continue to develop assessment and treatment planning
  3. Learn to perform a functional disability screen
  4. Learn interventions & management of functional disability (ies) once discovered
  5. Recognize ‘geriatric syndromes’ and have evaluation and treatment strategies
  6. Expand medical knowledge data base
  7. Develop positive attitudes regarding care of the older people.

Activities:

  1. Evaluate and manage geriatric patients from admission to hospital until discharge from UNMC campus.
  2. Participate in Geriatric Assessment Clinic.
  3. Geriatric Case Conferences, Didactic lectures with faculty, teaching rounds on the inpatient service, readings, Journal Club and (per attendings choice) give short presentation on a assigned geriatric topic. 

Educational Objectives

The resident through the course of the rotation will:

  1. Learn and Utilize measures to reduce functional decline and minimize functional disability.
  2. Learn and Utilize measures to reduce risk of delirium.
  3. Learn and Utilize measures to reduce pressure injury of the skin.
  4. Demonstrate appropriate fluid management in older people accounting for age related changes in thirst, renal and cardiac function.
  5. Recognize risk factors for nutritional deficiency and utilize appropriate nutritional support and risk factor modification.
  6. List risk factors for falls and demonstrate appropriate evaluation and management to reduce risk.
  7. List causes of iatrogenesis and demonstrate evaluation and management techniques to reduce iatrogenic complications.
  8. Determine the goals of treatment per patient/family wishes and encourage use of advanced directives.
  9. Model and encourage excellent Family/Loved-One or caregiver interaction.
  10. List the differential diagnosis of common geriatric syndromes. (see below*)
  11. Demonstrate appropriate evaluation and management of common geriatric syndromes.
  12. Provide appropriate pre-operative evaluation and perioperative management.
  13. Demonstrate appropriate evaluation and management of acute delirium.
  14. Demonstrate appropriate evaluation and management of common acute illnesses in the geriatric patient.
  15. Interact with the interdisciplinary team to provide optimal care.
  16. Demonstrate comprehensive discharge planning.
  17. Demonstrate awareness of health care costs and strive to provide efficient cost-effective care.
  18. Demonstrate appropriate end of life care and counseling of patient and family/loved-ones.
  19. List the benefits, types of patients that would benefit, and the process of comprehensive geriatric assessment.
  20. Describe the unique aspects of disease prevention in the elderly and apply appropriate preventive measures in the care of the elderly.
  21. Formulate treatment plans for individual patients and incorporate the biopsychosocial aspects of the disease by recognizing the importance of the caregiver and the family's role in the ongoing care of the elderly patient.
  22. Perform a functional assessment of the elderly patient and use this assessment in evaluation and treatment.
  23. Recognize preconceptions and biases concerning care of the elderly patient and acquire an enhanced positive attitude toward the aged.
  24. Discuss community resources available to assist in the care of the elderly.

Skilled Nursing Facilities

(A Subacute Care Unit for rehabilitation and management of protracted illnesses)

Objectives: (includes the acute care objectives listed above)

  1. Describe the indications for short-term skilled care stays following acute stays.
  2. Perform intervention & management of functional disabilities.
  3. Diagnose, evaluate, and manage common geriatric syndromes & rehabilitation problems.
  4. Become familiar with the role of physical therapy, their capabilities, the use of assist devices, and indications for referral.
  5. Become familiar with the role of occupational therapy, their capabilities, and use of assist devices for upper extremities, and what can be accomplished on a home visit.
  6. Become familiar with the role of speech therapy, their capabilities, and indications for referral.
  7. Master performance of functional disability screening.

Home Care

Home Visit Program for Internal Medicine Resident rotating through Geriatrics Service

Goal:

The home visit allows the house officer to provide medical care in the home and recognize the value of home-based medical assessment and treatment. The experience will foster an appreciation of the interaction between the elder's physical health, his/her environment and psychosocial situation, and provide an opportunity to practice "the art of medicine". This positive experience is designed tool generate an increased interest in providing home visits after his/her training is completed.

Objectives:

At the end of the home visit, the resident will be able to:

  1. Discuss appropriate indications for home visits.
  2. Describe the advantages of providing medical care in the elder's home.
  3. Discuss barriers to and limitations of house calls.
  4. Discuss equipment, supplies, and forms that may be useful to bring for a home visit,
    realizing that a stethoscope is often the only medical equipment that may be necessary.
  5. Describe medicare documentation requirements for physician home visits.
  6. Discuss environmental assessment to identify hazards and barriers in the home (Home
    Safety Evaluation), and recognize potential safety hazards in the home.
  7. Describe medicare reimbursement rules for physician home visits. Contrast the reimbursement for professional services for a similar level of service provided in the home
    vs. the office vs. an assisted living facility location.
  8. Contrast out-of-pocket costs for the elder considering home treatment of an acute illness
    (eg., course of I.V. antibiotics administered at home for pneumonia) vs. the elder's deductible expense for an acute care admission.
  9. Discuss strategies to maximize the efficiency of house calls.
  10. Discuss the value of the interdisciplinary team process to provide optimal care in the home.
  11. Identify situations when home care is not appropriate or safe for the elder.
  12. Discuss procedures to ensure the safety of the health care provider.
  13. Describe how house calls can enhance the physician-patient relationship.
  14. Describe the advanced treatment interventions that can be provided in the home setting.

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