Geriatric Care

GERIATRIC CARE

Rationale

Geriatric patients often have multiple, chronic illnesses which may present with atypical symptoms. Management strategies need to take into account the effects of aging on multiple organ systems and socioeconomic factors faced by our elderly society. As the number of geriatrics patients steadily rises, the internist will devote more time to the care of these patients.

Knowledge

Students should be able to describe:

functional implications of aging on each major organ system.

nutritional needs of the elderly and adaptations needed in the presence of chronic illness.

key illnesses in the elderly, focusing on their often atypical presentation:

cardiovascular disease

diabetes

urinary tract infection

pneumonia

substance abuse

depression

thyroid disease

arthritis

acute abdomen

basic treatment plans for illness in the elderly, with an awareness of the pharmacokinetic changes seen as we age.

approach, differential, and basic work-up of common symptoms in the elderly:

joint pain

dyspnea

dizziness

fatigue

constipation

anemia

sexual dysfunction

incontinence

weight loss

sleep disturbance

principles of screening in the elderly, including:

immunizations

cardiovascular risk

cancer

substance abuse

mental illness

osteoporosis

functional assessment

principles of Medicare (including who and what services are covered) and prescription drug coverage (who and what drugs are covered).

Skills

Students should demonstrate specific skills, including:

History-Taking Skills: Students should be able to:

take a complete and focused history from a geriatric patient with attention to:

current symptoms

chronic illnesses

physical and mental functioning

perform a physical examination and functional assessment on an elderly patient, adapting it to a patient’s:

symptoms

chronic illness, and possible conditions of frailty

immobility

hearing loss

memory loss

other impairments

perform a mental status examination to evaluate confusion and/or memory loss in an elderly patient

identify patients at high risk for falling

participate in an interdisciplinary approach to management and rehabilitation of elderly patients.

Attitudes and Professional Behaviors

Students should be able to:

always obtain historical information from significant others, whenever possible.

respect the increased risk for iatrogenic complications among elderly patients by always taking into account risks and monitoring closely for complications.

demonstrate respect to older patients, particularly those with disabilities, by making efforts to preserve their dignity and modesty.

always treat cognitively impaired patients and patients at the end of their lives with utmost respect and dignity.

Resources

1. Clerkship Seminar, “Problems in Elders”, R. Rosher, MD and S. Robinson, PhD

2. Doctoring Session, “Aging Across the Curriculum – Falls and Functional Decline, G. Rull, MD

3. Internal Medicine Clerkship Guide, Paauw, et al, Mosby 2003, pp 291-302

4. Guidelines for the Prevention of Falls in Older Person, American Geriatrics Society, Journal of the American Geriatrics Society, Vol. 49, pp 664-672, 2001

5. The Management of Persistent Pain in Older Persons, American Geriatrics Society, Journal of the American Geriatrics Society, Vol. 50, pp 205-224, 2002

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