The Portal of Geriatrics Online Education

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Hacking Geriatrics: The World 2 Challenge

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

The World 2 Challenge is an innovative quality improvement competition designed by our Reynolds Next Steps team, based on the concept of a healthcare hackathon.  We partnered with institutional leadership in our health system, graduate medical education leadership, nursing, physical therapy, pharmacy, and other interprofessional representatives to design a platform to promote friendly competition led by specialty faculty, fellows, and residents to improve the quality of care for older adults. In the process, they learn key principles of geriatrics and how to apply them at a broader level across the institution. Our first competition in April 2016 focused on improving communication at transitions of care for older patients.  At a retreat, 9 QI project "pitches" were delivered to a broad interprofessional audience, 5 were chosen by a voting process and developed their ideas further through interprofessional team collaboration. Ultimately, 2 project ideas were selected to go forward, and the ultimate winner of the QI competition will be the project with the most successful implementation and the broadest impact for the care of older patients institution-wide. This has been an energizing initial effort, and we look forward to its continuing for years to come because of several unique aspects that promote its success. The most important are the interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities to make actual change in the way that patients are cared for at our institution.  We provide a timeline that illustrates the key inputs and steps to promote such a QI competition to enhance geriatric education and care.  We also provide the event agenda, pitch template, judging template, list of pitch topics, and follow-up inhouse publicity from our institution to give our geriatrics colleagues at other institutions sample materials which could be adapted to their specific needs.

Educational objectives: 
  1. To demonstrate how geriatrics can lead and facilitate improvements in care across the broader institution through interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities, grounded in geriatrics principles.
Date posted: 
Mon, 10/17/2016
Date Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Hacking Geriatrics: The World 2 Challenge. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/37

IMPROVE Polypharmacy Clinic Resource Site

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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: 
3
Abstract: 

Polypharmacy and inappropriate prescribing are common among older adults. 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. The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) is an interprofessional polypharmacy clinic within an academic patient-aligned care team at the VA Connecticut Center of Excellence in Primary Care Education. The clinic consists of a pre-clinic conference, shared medical appointment, individual visit, and team precepting. The team consist of a pharmacist, geriatrician, primary care provider, and health psychologist and involves medicine residents, nurse practitioner residents, pharmacy residents, and psychology residents. This website describes the clinic design and provides the resources and links helpful for starting an IMPROVE Polypharmacy Clinic including forms, short topic discussions in polypharmacy, and various other resources helpful for deprescribing.

Educational objectives: 

This website:

1.  Describes the IMPROVE Polypharmacy Clinic design

2.  Provides resources needed to implement an IMPROVE Polypharmacy Clinic

3.  Provides handouts for short topic discussions on various polypharmacy-related topics and deprescribing

Date posted: 
Thu, 10/13/2016
Date Reviewed/Updated for Clinical Accuracy: 
Thu, 10/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
IMPROVE Polypharmacy Clinic Resource Site. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/37

Geriatricized H&P with Function and Delirium Risk Assessments

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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: 
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/37

SAGE Intrinsic Aging: A Histological Perspective: Musculoskeletal System

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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: 

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 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/37

EPIC Delirium Prevention and Treatment Sets and Stop Orders

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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: 
0
Abstract: 

Best practices for delirium prevention and management are reinforced/engineered through our  EPIC order sets and treatment protocols. Geriatric education and training activities are linked to these to assure the best of geriatric patient-centered care. 

Educational objectives: 

To explain the clnical components of delirium prevention 

To explain the clinical components of delirium management

To describe the role of the EHR in sustainability of quality care

Date posted: 
Mon, 10/05/2015
Date Reviewed/Updated for Clinical Accuracy: 
Mon, 10/05/2015
Contact Person/Corresponding Author:



Suggested Citation:
EPIC Delirium Prevention and Treatment Sets and Stop Orders. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/37

Multiple Chronic Conditions: Geriatrics Evaluation and Management Strategies (MCC GEMS) App

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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: 
0
Abstract: 

With a grant from the Agency for Healthcare Research and Quality (AHRQ), The American Geriatrics Society (AGS) has developed the Multiple Chronic Conditions: Geriatrics Evaluation and Management Strategies App (MCC GEMS) to address one of the greatest challenges in clinical care of older adults: providing optimal care for frail elders with multiple chronic conditions, or multimorbidity. 

Educational objectives: 

The MCC GEMS App will help guide the clinician through an approach to managing patients with multimorbidity, one that is built on a firm understanding of the principles of evidence-based medicine, patient preferences and goals of care, clinically feasible methods for understanding prognosis, and the multi-factorial geriatric issues and syndromes that may be consequences of the combinations of diseases and conditions (e.g., polypharmacy). This Approach is based on the AGS’s Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians.

Additional information/Special implementation requirements or guidelines: 

Login to www.GeriatricsCareOnline.org to view the accompanying online educational toolkit http://geriatricscareonline.org/toc/multimorbidity-toolkit/TK011.

Date posted: 
Thu, 06/11/2015
Date Reviewed/Updated for Clinical Accuracy: 
Thu, 06/11/2015
Product Viewing Instructions: 
Contact Person/Corresponding Author:



Suggested Citation:
Multiple Chronic Conditions: Geriatrics Evaluation and Management Strategies (MCC GEMS) App. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/37

Social Services with Older Adults Assignment

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Abstract: 

Undergraduate social work students participate in a semester-long person-centered care project with memory impaired residents at an assisted-living facility. Service activities culminate in oral history interviews of residents gathered by students as a strategy to introduce students to principles of person-centered care. To prepare for engaging with residents, students complete a series of web-based tutorials on basic communication skills with older adults, read literature on communication from the Alzheimer’s Association, and view an in-class video on effective communication with older adults who have dementia. 

Educational objectives: 

Students apply person-centered care principles through individualized social engagement activities with residents of an assisted living facility.

Date posted: 
Tue, 02/24/2015
Date Reviewed/Updated for Clinical Accuracy: 
Tue, 02/24/2015
Contact Person/Corresponding Author:



Suggested Citation:
Social Services with Older Adults Assignment. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/37

SAGE Intrinsic Aging: A Histological Perspective: Urinary System Module

:  
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 urinary system and its clinical implications. A highlight of these modules are side by side comparison 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 Urinary System module:

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

  1. Kidney
  2. Ureter
  3. Urethra - female
  4. Nerves
  5. Urethra - male
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:  Amit Shah, MD

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

Date posted: 
Thu, 12/18/2014
Date Reviewed/Updated for Clinical Accuracy: 
Thu, 12/18/2014
Contact Person/Corresponding Author:



Suggested Citation:
SAGE Intrinsic Aging: A Histological Perspective: Urinary System Module. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/37

SAGE Intrinsic Aging: A Histological Perspective: Cardiovascular 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 normal changes of aging and the clinical implications of these aging-related changes via histology. A highlight of these modules are side by side comparison 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. The modules could be used in geriatrics fellowship programs to teach the basic science of aging.

Educational objectives: 

Learning Objectives for Cardiovascular module:

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

  1. Endothelial cells
  2. Elastic arteries
  3. Muscular arteries
  4. Arterioles
  5. Capillaries
  6. Small and medium veins
  7. Large veins
  8. Heart
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: Amit Shah, MD

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

Date posted: 
Thu, 12/18/2014
Date Reviewed/Updated for Clinical Accuracy: 
Thu, 12/18/2014
Contact Person/Corresponding Author:



Suggested Citation:
SAGE Intrinsic Aging: A Histological Perspective: Cardiovascular System. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/37

SAGE Intrinsic Aging: A Histological Perspective: Blood & Defense 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 blood and defense systems and their clinical implications. A highlight of these modules are side by side comparison 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 Blood & Defense System module:

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

  1. Blood and innate immunity
  2. Hematopoiesis
  3. Lymphocytes & adaptive immunity
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 technician: Brie Thaden Pirkle

 

Contact Person/Corresponding Author:



Suggested Citation:
SAGE Intrinsic Aging: A Histological Perspective: Blood & Defense System. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/37

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