Geriatrics

Geriatric Service: Sub-Internship

FACULTY:
Jane Potter, MD, (Division Chief) 
Stephen Bonasera, MD
Catherine Eberle, MD
Elizabeth Harlow, MD
Brenda Keller, MD 
William Lyons, MD  
Debra Mostek, MD 
Edward Vandenberg, MD

DURATION:  1 month
  
OPTIONS:
Note: The Sub Intern candidate should contact at least 1 months prior to rotation. Contact Travis Weyant (402-559-3964) or tweyant@unmc.edu.

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.

Goals:

  1. Improve student's skills and knowledge regarding evaluation and treatment of common geriatric syndromes and health problems across the continuum of care.
  2. Develop positive attitudes regarding care of the older people.

Activities:

  1. Evaluate and manage geriatric patients from admission to hospital or rehabilitation unit until discharge from UNMC campus.
  2. Geriatric Case Conferences, didactic sessions with faculty, teaching rounds on inpatient and TRU, readings, videotapes and (per attending's choice) give short presentation on a assigned geriatric topic.
  3. As time permits become involved in patients post discharge outpatient follow-up appointments and care.

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 geriatric syndrome checklist on this web page*)
  11. Demonstrate appropriate evaluation and management of common geriatric syndromes.
  12. Provide appropriate pre-operative evaluation and peri-operative 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.
  25. Home Care Goal: The home visit will allow the Sub Intern (M-4) 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 to 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. Discuss environmental assessment to identify hazards and barriers in the home (Home Safety Evaluation), and recognize potential safety hazards in the home.
  6. Discuss strategies to maximize the efficiency of house calls.
  7. Discuss the value of the interdisciplinary team process to provide optimal care in the home.
  8. Identify situations when home care is not appropriate or safe for the elder.
  9. Discuss procedures to ensure the safety of the health care provider.
  10. Describe how house calls can enhance the physician-patient relationship.

Hospice Care At the end of his/her experience, the sub-intern will:

  1. Recognize the signs and symptoms of actively dying patients.
  2. Will be able to identify and access needed resources when treating terminally ill persons. Hospice, Chaplain, Nursing, etc.
  3. Will be able to assess and initiate treatment of pain in terminally ill patients. This includes conversion of opiates and po to iv and back.
  4. Will be able to assess and manage other distressing symptoms commonly seen in terminally ill persons e.g., dyspnea,/air hunger, nausea, vomiting, depression, fatigue, grief.
  5. Sub-intern will be able prepare and initiate patient-family-team care conferences. (Never asked to do without attending presence.)

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