SIU School of Medicine

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Department of Internal Medicine

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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