The Portal of Geriatrics Online Education

Resident

Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Discussing Cognitive Aging with Patients and Families is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Define cognitive aging
  2. Explain the difference between fluid intelligence and crystalized intelligence
  3. Identify a clinical test that can be used to assess speed of medical processing
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.  

Date posted: 
Thu, 06/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/250

Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

In 2012, 5.4 million Americans are diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internal medicine residents have a structured approach to the evaluation and management of BPSD.  This is the 3rd topic covered in a four part ambulatory geriatric curriculum that was developed for internal medicine residents.  To learn more about the successful ambulatory curriculum developed, please  check out  manuscript by Chang C1, Callahan EH, Hung WW, Thomas DC, Leipzig RM, DeCherrie LV. A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report. Gerontol Geriatr Educ. 2015 Jul 9:1-15.

Educational objectives: 

At the conclusion of this module, learners will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
    • Nonpharmacologic Interventions
    • Pharmacologic Interventions
Publications from, presentations from, and/or citations to this product: 

Christine Changab*, Eileen H. Callahanab, William W. Hungc, David C. Thomasb, Rosanne M. Leipzigab & Linda V. DeCherrieab A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report Gerontology & Geriatrics Education. Published online: 09 Jul 2015. DOI:10.1080/02701960.2015.1031897.

Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/250

Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

In 2012, 5.4 million Americans were diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internist have a structured approach to the evaluation and management of BPSD. 

Educational objectives: 

Participants will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/250

Medication Review Worksheet 2015

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition.1  Primary care providers seek tools to address polypharmacy.This medication review worksheet facilitates a targeted chart review, the development of an indication-matched medication list, and the use of available resources related to potentially inappropriate medications,3,4,5,6 common disease-specific guidelines,7,8,9,10 and helpful calculators11,12,13,14 to develop an evidence-based deprescribing plan for use in geriatric primary care patients.

1.  Fried, TR, O'Leary J, Towle V, et al.  Health outcomes assoicated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc, 62: 2261-2272, 2014.

2.  Anthierens S, Tansens A, Petrovic M, et al.  Qualitative insights into general practitioners views on polypharmacy.  BMC Family Practice, 11(65): 1-6, 2010.

3.  American Geriatrics Society 2015 Beers Criteria Update Expert Panel.  American Geriatrics Society 2015 Updated Beers criteria for potentially inappropriate medication use in older adults.  J Am Geriatr Soc, Epub ahead of print, 2015.

4.  Steinman MA, Beizer JL, DuBeau CE, et al.  How to use the American Geriatrics Society 2015 Beers criteria-a guide for patients, clinicians, health systems, and payors.  J Am Geriatr Soc, Epub ahead of print, 2015.

5.  Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures.  J Am Geriatr Soc, Epub ahead of print, 2015.

6.  O'Mahony D, O'Sullivan D, Byrne S, et al.  STOPP/START criteria for potentially inappropriate prescribing in odler people: version 2.  Age and Ageing, 0:1-6, 2014.

7.  James PA, Oparil S, Carter BL, et al.  2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8).  JAMA, 311(5): 507-20, 2014.

8.  Stone NJ, Robinson J, Lichtenstein AH, et al.  2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.  Circulation, 129(25 Suppl 2):S1-45, 2014.

9.  American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus.  Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update.  J Am Geriatr Soc, 61:2020-26, 2013.

10.  American Diabetes Association.  Standards of medical care in diabetes-2014.  Diabetes Care, 37(S1):14-80, 2014.

11.  Multiple creatinine clearance methods.  Global RPh.  Available http://www.globalrph.com/multiple_crcl_2012.htm

12.  Hwang C.  CHA2DS2-VASc score for atrial fibrillation stroke risk.  MD+Calc.  Available http://www.mdcalc.com/cha2ds2-vasc-score-for-atrial-fibrillation-stroke-risk/

13.  Andrade, J.  HAS-BLED Score.  QxMD.  Available http://www.qxmd.com/calculate-online/cardiology/has-bled-score-bleeding-in-atrial-fibrillation

14.  2013 Prevention Guidelines Tools: CV Risk Calculator.  American Heart Association and American College of Cardiology.  Available at http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp

Educational objectives: 

This medication review worksheet will help trainees to:

1.  Complete a targeted chart review

2.  Reconcile a patient's medications by indication

3.  Develop an evidence-based strategy for deprescribing potentially inappropriate medications

Contact Person/Corresponding Author:



Suggested Citation:
Medication Review Worksheet 2015. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

Gait Velocity Assessment Toolkit

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

Gait Velocity is a marker of functional and cognitive status in older adults.  Slow gait speed has been associated with poor clinical outcomes such as cognitive decline, falls and hospitalization. This toolkit provides  instructions on how to perform a gait speed or gait velocity assessment.  It includes START and STOP labels, labels for the Timed Zone, and instructions on how to interprete and apply the results.  The examiner will need to measure and mark a walkway, and supply a stopwatch or watch with a second hand. By following these simple steps, gait velocity assessment can become a routine practice for clinicians who care for older adults.

Educational objectives: 

1. Describe how to perform and interpret gait velocity assessment in older adults.

2. Discuss the clinical implications of slow gait speed

Date posted: 
Fri, 10/09/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 04/13/2018
Contact Person/Corresponding Author:



Suggested Citation:
Gait Velocity Assessment Toolkit. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

Geriatric Fast Facts Quizzes

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

Geriatric Fast Facts (GFFs) [www.geriatricfastfacts.com] is a mobile enabled website which contains 1-2 page concise, peer-reviewed evidence-based educational summaries on key geriatrics topics to increase medical knowledge.

GFF Quizzes are quick, online assessment tools paired with GFF content, to be used by learners at the point of care to assess knowledge of geriatric content aligned with ACGME Milestones.  Design elements include quiz content searchable by topic, links to corresponding GFFs, MCQ/ short answer question formats and ability to include images. Learners enter brief demographic information to start (institution, email of self and up to 1 other) allowing annotated score results, displayed immediately after quiz completion, to be sent to themselves and one other individual (faculty, program director). These quick quizzes, available on hand held mobile devices at the point of care, linked to GFF content provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Educational objectives: 

The Geriatric Fast Fact (GFF) quizzes, available on hand held mobile devices at the point of care, linked to GFF content will provide learners and program directors information of learner knowledge assessment linked to ACGME Milestones.

Additional information/Special implementation requirements or guidelines: 

The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed and accessed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app".

Publications from, presentations from, and/or citations to this product: 

Quick Quizzes:  Geriatrics Right in Your Hand & at the Point of Care.  Denson K, Simpson D, Padua K, and the GET Collaboratives at the Medical College of Wisconsin & Aurora Health Care, American Geriatrics Society Annual Meeting, Baltimore, MD, 05/2015

Date posted: 
Thu, 10/08/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/08/2015
Product Viewing Instructions: 
The Geriatric Fast Facts (GFF) and GFF Quizzes may be viewed by the URL address geriatricfastfacts.com. The site may be then saved to the home screen to allow functionality as an "app"
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Fast Facts Quizzes. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

Error Disclosure: An Interprofessional Clinical Skills Session

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

The goal of this clinical skills session is for students to gain skills in working in teams during a particularly difficult situation: the team disclosure of medical errors.  There will be an encounter with a standardized patient (SP) acting as a family member, followed by feedback from the SP and for some students, a review of the recorded interview in a meeting with their mentors and mentor group.

Educational objectives: 

At completion of this case, the student will demonstrate effective team communication behaviors when:

  1. Discussing a medical error (by demonstrating four important principles),
  2. Planning for the disclosure (by demonstrating three important principles), and
  3. Conducting the disclosure (by demonstrating eight important principles).

The principles mentioned above are described in the online module.

Date posted: 
Mon, 10/12/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/12/2015
Product Viewing Instructions: 
Video can be accessed via geriSAGE.com>Educational Modules "Interprofessional web-GEM on Values & Ethics". Handout can be accessed on geriSAGE.com>Resources link>"IP Error Disclosure Handout"
Contact Person/Corresponding Author:



Suggested Citation:
Error Disclosure: An Interprofessional Clinical Skills Session. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

Palliative Care Case

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
3
Abstract: 

Using a case study participants will follow an older patient who requires increasing levels of care. After breaking into interdisciplinary teams led by leaders in transitions of care, participants will discuss goals, long-term care planning, and transitions in and out of hospital.

 

Educational objectives: 

Upon completion participants will be able to:

  • Describe how a multidisciplinary team approach enhances quality of life for patients throughout the aging process.
  • Recognize the importance of understanding a patient’s values, goals, and beliefs while assisting with transitions of care and long-term care planning.
Date posted: 
Wed, 09/30/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 09/30/2015
Contact Person/Corresponding Author:



Suggested Citation:
Palliative Care Case. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

Geriatricized H&P with Function and Delirium Risk Assessments

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
0
Abstract: 

One important goal of the Wake Forest Geriatrics Principles for Specialists program is to train faculty, chief residents and fellows in the use of quality improvement techniques to enhance care for older adult patients that they serve.  As a product of this effort, chief residents and their faculty mentors in General Internal Medicine developed functional assessment and delirium risk assessment tools that have been incorporated into the history and physical template of the electronic medical record (EMR) to identify pre-hospital functional and cognitive limitations that affect admitted patients age 65 or older.  At present these tools are found in the note template of the following services: four general medicine teaching services, two cardiology services, the renal service, the hematology oncology service, the leukemia service, the Acute Care for the Elderly service, the cardiac critical care service, and the medical intensive care service. 

The functional assessment, implemented in July 2014, includes four questions to help determine a patient’s baseline functional status, including ability to complete activities of daily living and independent activities of daily living, ambulation status, and pre-hospital residence.  Analysis involving chart reviews pre-and post- functional assessment tool implementation showed increased documentation of functional history data in the EMR. 

The delirium risk assessment, implemented in July 2015, includes four items to help identify a patient’s cognitive status, including age greater than 80, a reverse spelling task, orientation to location, and illness severity.  Analysis of delirium incidence of hospitalized patients pre- and post- delirium risk tool implementation is planned for fall 2015.  Our hypothesis is that delirium incidence will rise as awareness and watchfulness by providers increases with use of the tool. 

While the results of implementing these physical and cognitive assessment tools are preliminary or still in process, anecdotal feedback received from case managers and other stakeholders in the discharge planning process indicate that they find such information incorporated in the H&P by admitting physicians to be valuable.  Further study is needed to determine whether such documentation expedites discharge planning, improves use of therapy services, or improves readmission rates or morbidity outcomes.  Next steps planned beyond testing of the delirium assessment tool include implementing a delirium prevention order set to standardize measures taken to decrease delirium among inpatients, followed by further evaluation of changes in delirium incidence, and eventual implementation of a delirium management order set.  The success of these measures within Internal Medicine could encourage roll-out of these tools institution-wide.

An additional benefit of this effort has been the educational value of supporting the training of residents in informatics so that they can contribute to developing solutions for improving patient safety and quality of care.  

Educational objectives: 
  1. To train residents and faculty in quality improvement techniques for the purpose of enhancing quality of care and patient safety for older adult patients.
  2. To involve residents in developing EMR tools that emphasize the importance of physical and cognitive assessments when admitting older adult patients to the hospital.
  3. To provide training opportunities in EMR informatics for residents and junior faculty.
Publications from, presentations from, and/or citations to this product: 

M. Wesley Milks, Farra Wilson, Ajay Dharod and Kirsten Feiereisel.  Abstract 347:  Identification of Functional Limitations on Admission by Internal Medicine Resident Physicians.  Circulation: Cardiovascular Quality and Outcomes. 2015;8:A347.

Contact Person/Corresponding Author:



Suggested Citation:
Geriatricized H&P with Function and Delirium Risk Assessments. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

SAGE Intrinsic Aging: A Histological Perspective: Musculoskeletal System

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This module demonstrates the normal age-related changes in the musculoskeletal system and their clinical implications. A highlight of these modules are side by side comparisons of young and aged tissues with interactive slides and summary drawings which reinforce the main points on the histology slides. The curriculum is appealing to clinical learners as it is anchored in showing clinically relevant changes and the implications of these changes in older patients. The main audience is the pre-clinical first or second year medical student, but these could be used by other trainees to teach the basic science of aging.

Educational objectives: 

Learning Objectives for Musculoskeletal System module:

Identify the major aging associated changes in each of the following and describe the clinical implications of these changes:

  1. Muscle
  2. Tendons & ligaments
  3. Cartilage
  4. Bone
  5. Spine
Additional information/Special implementation requirements or guidelines: 

Southwestern Aging and Geriatrics Education (SAGE) Program

Lead Author: Judith R. Head, PhD

Medical Illustrator: Lindsay Oksenberg, MA

Geriatrician Author/Clinical Correlations: Amit Shah, MD

Special thanks to histology technicians: Brie Thaden Pirkle and Tasha Buxton

Date posted: 
Wed, 12/09/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/09/2015
Contact Person/Corresponding Author:



Suggested Citation:
SAGE Intrinsic Aging: A Histological Perspective: Musculoskeletal System. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/250

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