• The resident will gain knowledge, skills, and attitudes necessary to evaluate and manage issues involving older people, including physiology and pathology of aging, medical conditions of aging, life cycle development and challenges, family, community and interdisciplinary interactions.
• The resident will understand systems and resources that involve older patients.
  

The resident should develop attitudes that encompass the following:

• An awareness of the importance of the physician’s own attitudes to aging, disability, death, and prolonging life in mentally deficient
• The promotion of dignity and health ownership through self-care and self-determination.
• Patient and family involvement in determining course of investigation and treatment
• An awareness of the benefits and limitations of advanced directives, living wills, durable powers of attorney, surrogate designation
• Psychosocial, pain relief, right to self-determination, dignity, spiritual issues and family dynamics affecting the terminally ill patient.

The resident should demonstrate sufficient knowledge of the following principles and conditions:

• Physiology of normal aging
• Psychological, social and environmental changes of aging
• Health promotion-screening, preventative care, early diagnosis and risk assessment of disease
• Rehabilitation services, long term care facilities and alternative housing
• Home visits
• Counseling on exercise, nutrition and psychosocial issues
• Evaluation of the functional status of a patient and appropriate interventions
• Palliative care/hospice care
• Major physiological pain syndromes-visceral, bone, neuropathic
• Nutrition/hydration-gastric tubes and parenteral
• Withholding or withdrawing life support
• Medicare prescribing of medical equipment
• Pronouncement of death/death certificates
• Nursing home facility evaluation and directorship
• Community services—Case Coordination Unit, Area Agency on Aging, Senior Citizens Center, Meals on Wheels
• Geriatric literature and web resources
• Conditions of the elderly including:
  • Abuse (physical and psychological)
  • Alcoholism/substance abuse
  • Altered mental status/confusion/delirium/dementia
  • Anemia
  • Anorexia/malnutrition
  • Atypical malignant presentations
  • Bacteriuria/UTI
  • Bereavement
  • Catheterization indications and care
  • Completed stroke /TIA/RIND prevention and intervention
  • Congestive heart failure prevention and intervention
  • Constipation/Fecal Impaction prevention and intervention
  • Contractures prevention and intervention
  • Degenerative joint disease
  • Dehydration
  • Dentition
  • Diabetes
  • Dizziness/postural hypotension/Syncope
  • Depression/anxiety
  • Drug-induced illness/medication interaction
  • Falls prevention and intervention
  • Fatigue/weakness
  • Flexibility
  • Gait disorders
  • Hearing loss – Prevention and intervention
  • Hip fractures - Prevention/PostOp Care/Rehabilitation
  • Hypertension – Prevention and intervention
  • Hypothermia
  • Hypothyroidism
  • Intensive Care unit syndrome
  • Incontinence – Prevention and intervention
  • Insomnia – multiple modalities
  • Psychological effects of illness
  • Myocardial infarction – prevention and intervention
  • Pain assessment and management
  • Osteopenia/osteoporosis - screening, prevention and intervention
  • Perioperative problems
  • Pneumonia/respiratory infections
  • Pressure sores – risk factor, screening, prevention and intervention
  • Podiatric problems
  • Renal & electrolyte problems
  • Restraint use – pharmological and physical
  • Sexual problems
  • Skin cancers
  • Speech disorders – speech therapy role, interventions
  • Stiffness
  • Temporal arteritis
  • Terminal care
  • Tremor/parkinsonism
  • Thromboembolism
  • Vision loss
  • Xerostomia

The resident should demonstrate proficiency in the following management and therapeutic skills:
Mental status exam

• Use of controlled substances
• Use of alternative routes of administration of analgesia
• Referral to available social services
• Audiometry/indications for hearing aids
• Visual screening, preservation, low vision aids
• Use of appliances/catheters/prosthesis/tubes
• House calls/ nursing home visits
• Interpretation of laboratory tests and selection of diagnostic procedures for the elderly
• Counseling about psychological, social and physical stresses and changes of age, dying, and death
• Consulting with physicians and other healthcare professionals, including the critical evaluation and selective use of consultant advice and the integration of management in critical care situations

• Nursing Home Patients
• ADD: continuity clinic patients, geriatric immersion experience, conferences and home visits (at least 2)

• Discuss and be aware of physician’s attitude toward aging, disability, and death, prolonging life in mentally deficient.
• Hospice home visit and team report identify team players and role
• Process of breaking bad news, using appropriate wording and answering questions, follow up
• Spiritual attitudes

• Discuss and be aware of physician’s attitude toward aging, disability, and death, prolonging life in mentally deficient.
• Hospice home visit and team report identofy team players and role
• Process of breaking bad news, using appropriate wording and answering questions, follow up.
• Spiritual attitudes

• Hospice home visit and team report identify team players and role
• Interdisciplinary care
• Senior citizen’s center
• Agencies that assist the elderly (Area Agency on Aging, Meals on Wheels, etc.)
• Geriatric immersion experience

• Acute illnesses of children, trauma

• Promotion of dignity and health ownership through self-care and self-determination
• Long-term care of elderly patients

• Patient and family involvement in determining course of investigation and treatment
• Acute medical problems of elderly

• Assessment of information learned through home visit, not seen through office visit
• Assessment of value/cost of home visit
• Gait assessment, home safety assessment
• Home Visit Scheduling Protocol

• Observe process of physician advisor in interdisciplinary QA process

• Interdisciplinary care
• Outreach – visit with elder abuse evaluation or attend elder abuse meeting
• CCU
• Area Agency on Aging
• Senior Citizens Center
• Meals on Wheels

• 10 medical problems – See outline
• July Aug of each month transition

• Note difference in services available for the elderly and methods of adjustment
• Rural nursing home – note differences compared to the residents regular nursing home

• Appropriate approach to elderly patient

• Geriatric Portion

• Elderly abuse patters +/- are they at recovery resources, is the # less or not recognized

• Ortho – Hip Fx – post op rehab
• ENT – Indications for hearing aids
• Ophth – Preservation of sight and low vision aids
• Uro – Incontinence evaluation and treatment
• Gyn – Hormone use, atrophic vaginitis

• www.amda.com (nursing home director information)
• www.americangeriatrics.org/
• http://www.eperc.mcw.edu (end of life information)
• http://osteoed.org/ (osteoporosis)
• Minimizing Adverse Drug Events in Older Persons (AAFP)
• Geriatrics At Your Fingertips