Geriatrics

Educational Plan: A competency based development of knowledge and skills in Geriatrics through clinical experience, bedside teaching, didactic conferences and readings to achieve competence, proficiency and the foundation for mastery. 

Educational Methods:

Clinical Information and Didactics

• Residents on rotation will meet with Dr. Arseven for the rotation orientation on the first day (Friday) at 8:30 am in the Geriatric Academic Office (645 N. Michigan Ave. Suite 630). Rotation schedules, including detailed contact information will be delivered to the resident through e-mail before the beginning of the rotation. Please contact to Adnan Arseven, MD (pager 5-3380; a-arseven@northwestern.edu) for general information.
• Didactic conference (TBD per block): Informal cased based discussions, twice weekly. Residents will be asked to prepare a cased base brief talk during their rotations.
• Present one clinical topic from the Key Topics list below, or from a geriatric aspect of a subspecialty discipline, or review a geriatric journal article critically.

PGY2:

• A 2-week rotation (in combination with 2 weeks of Ambulatory medicine) with services provided to:
  • Outpatient geriatric assessment and primary care (Galter 14-100)
  • Bone Health
  • Post acute and long term care (RIC)
• Outpatient comprehensive geriatric assessments (CGA) are seen by the interdisciplinary team (IDT), which includes a nurse and clinical social worker. The resident will observe the whole process once and then participate in 1-2 CGA.  The resident will present interesting cases in the ITD meeting the following Wednesday.
• Practice Improvement Module (PIM): Care for the Vulnerable and Elderly – Residents will participate in quality improvement activities including:
  • Patient Survey, Chart Review and Systems Analysis

PGY3:

• A 2-week rotation (in combination with 2 weeks of Neurology) with services provided to:
  • Inpatient consultation (NMH, Older Adult Psychiatry Unit / Stone and Prentice)
  • Post acute and long term care (Warren Barr)
• Subacute and Long-Term Care experience is obtained at Warren Barr. The resident will join the rounds in the nursing home weekly.  Residents are able to follow some of the patients who are initially seen by the consult team.

Evaluation: Click here

Goals and Objectives: Review the 6 core competencies that apply to your clinical rotations.Click here.

• Perform a focused geriatric assessment (cognitive, functional and physical).
• Recognize, assess and treat dementia, delirium, mobility impairment and falls, urinary incontinence, weight loss and insomnia.
• Review preventive medicine including nutrition, exercise and screening for and immunization against disease.
• List ethical and legal issues including elder mistreatment, limitations of treatment, right to refuse treatment, advance directives and durable power of attorney for medical and financial affairs.
• Introduce concepts of geriatric psychiatry and the management of patients with depression including exposure to pharmacologic and electroshock therapy.
• Describe general principles of geriatric rehabilitation applicable to patients with orthopedic, rheumatologic, cardiac, and neurological impairments in the inpatient and outpatient settings.
• Review the pivotal role of the family and other caregivers in caring for many elderly and the resources required supporting patient, family and caregiver.
• Discuss socio-economic aspects of aging, including housing, coverage and costs of health care.
• Obtain skills in assessing:
  • Cognition
  • Depression
  • Nutrition
  • Hearing and vision
  • Gait
  • Function (ADL/IADL)
  • Incontinence
• Examples of Key Topics:
  • Acute pain management
  • Cognitive assessment and related issues (I.e. dementia, delirium)
  • Dental assessment
  • Evaluation of swallowing, disorders with swallowing impairment
  • Falls and fall prevention
  • Osteoporosis
  • Nutritional assessment
  • Weight loss
  • Polypharmacy
  • Preventive care of older adults
  • Physical therapy
  • Elder abuse
  • Community resources and levels of assisted living

Top Ten References

1. Philip S. Wang, M.D., Dr.P.H., Sebastian Schneeweiss, M.D., Jerry Avorn, M.D.,Michael A. Fischer, M.D., Helen Mogun, M.S., Daniel H. Solomon, M.D., M.P.H., and M. Alan Brookhart, Ph.D. Risk of Death in Elderly Users of Conventional vs. Atypical Antipsychotic Medications. NEJM 353;22 December 1, 2005; 2335-2341.
2. Donna M. Fick, PhD, RN; James W. Cooper, PhD, RPh; William E. Wade, PharmD, FASHP, FCCP; Jennifer L. Waller, PhD; J. Ross Maclean, MD; Mark H. Beers, MD. Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults; Results of a US Consensus Panel of Experts. Arch Intern Med. 2003;163:2716-2724.
3. Sharon K. Inouye, M.D., M.P.H. Delirium in Older Persons. N Engl J Med 2006;354:1157-65.
4. Claudia H. Kawas, M.D. Early Alzheimer’s Disease. N Engl J Med 2003;349:1056-63.
5. Martin J. Gorbien, MD, FACP*, Amy R. Eisenstein, MA. Elder Abuse and Neglect: An Overview. Clin Geriatr Med 21 (2005) 279– 292 ( This article can not be directly linked. Once in the Clinics in Geriatric Medicine journal via the above link, search by entering the author's name (Gorbien M J) and the year (2005). Click on Search and select the article.)
6. Thomiias M. Gill, MD, Christiannla S. Williamiis, MPH, Julie T Robison, PhD, anid Mary E. Tinietti, MD. A Population-Based Study of Environmental Hazards in the Homes of Older Persons. Am J Public Health. 1999;89:553-556
7. Dan H. Bourla, MD, and Tara A. Young, MD. Age-Related Macular Degeneration: A Practical Approach to a Challenging Disease. JAGS 54:1130–1135, 2006.
8. American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guidlines for the Prevention of Falls in Older Persons. JAGS 49:664-672, 2001.
9. Joe Verghese, M.D., Richard B. Lipton, M.D., Mindy J. Katz, M.P.H., Charles B. Hall, Ph.D., Carol A. Derby, Ph.D., Gail Kuslansky, Ph.D., Anne F. Ambrose, M.D., Martin Sliwinski, Ph.D., and Herman Buschke, M.D. Leisure Activities and the Risk of Dementia in the Elderly. N Engl J Med 2003;348:2508-16.
10. Clifford J. Rosen, M.D. Postmenopausal Osteoporosis. N Engl J Med 2005;353:595-603.

Collection by Dr. Lee Lindquist

Additional educational materials:

• Geriatrics at your fingertips. Rueben DB, Herr K, Pacala JT. American Geriatric Society, New York 2005 (individual copy given at the beginning of the rotation).
• Computer-Based Self –Instruction Modules in Geriatric Medicine, Fourth Edition, Baylor-College of Medicine, 2001 & Web-Based Self-Instruction Modules in Geriatric Medicine.
• Essential of Clinical Geriatrics, Kane RL, Ouslander JG, Abrass, IB.  Fifth Edition, McGraw Hill, 2004
• Geriatric Medicine: An Evidence Based Approach (Christine Cassel, MD, editor). Fourth edition, 2003 (Online available at Galter Library website).

For an extended list of references with direct article links, sign in to the Galter Health Library website at: http://www.galter.northwestern.edu/guides/expand/resident-reading-lists