Year 4 HCOE4: Health Care of the Elderly
- Dr Dhanupriya Sivapathasuntharam,
- DHANUPRIYA.SIVAPATHASUNTHARAM@bartshealth.nhs.uk
Introduction
To facilitate the learning and teaching of Medicine for the Elderly by providing students with a diverse range of community and secondary care opportunities and experiences.
To give students an excellent grounding in the medical, multidisciplinary and social care of older people.
To challenge students’ pre-conceptions and prejudice about the care of older people.
Sessions
Lecture: Introduction to Healthcare of the Elderly
- Can describe the physiology of ageing (NB: British Geriatric Society Outcome).
- Know the difference between chronological, biological and functional age.
- Know the differences between normal ageing 'senescence' and common pathologies of old age.
- Can describe the biochemical, molecular, cellular, genetic theories of ageing.
- Can describe the pathology associated with normal ageing and age associated disease processes.
- Can describe the diagnosis, pathophysiology, management and preventative strategies for specific disease processes: dementia, delirium, depression, osteoporosis, falls, parkinsonism & movement disorders, cerebrovascular disease and stroke.
Lecture: Incontinence
- Understanding of the scale of the problem and impact that incontinence has on the individual
- Be able to take a focussed and diagnostic history of a patient presenting with incontinence.
- Aware of the different types of incontinence including stress, urge, mixed, functional and overflow.
- Know and understand how to investigate and manage an elderly patient with incontinence
- Aware of the causes of faecal incontinence.
- Know and understand how to investigate and manage an elderly patient presenting with faecal incontinence.
Lecture: Comprehensive Geriatric Assessment
Lecture: Elder Abuse
Lecture: End of Life and Palliative Care
- Know and understand common, serious conditions that cause older patients to present in extremis (click to see list).
- Know and understand the principles of discharge planning for patients with end stage disease and / or multiple palliative care needs.
- Appreciate the principles used to discuss the diagnosis, progression and terminal care of patients with a neurodegenerative disease e.g. dementia.
- Appreciate the palliative care principles used to in the management of patients at the end of life.
- Appreciate the principles used in discussing end of life care, CPR, and appropriateness of care with patients and carers.
- Know and understand the primary drug classes and members used in palliation of patients with serious, end stage disease, their indications, contra-indications, common side effects and interactions:
- Know and understand how to certify death, complete a death certificate and part 1 of a cremation form.
Lecture: Dementia
- Know the definition and differences between delirium and dementia.
- Be able to take an appropriate, focussed history, and examine a patient presenting with delirium and / or dementia.
- Know and understand how to investigate a patient presenting with delirium and /or dementia, including the ordering and interpretation of relevant tests.
- The common causes of dementia (click here for details).
- Describe the pathology, presentation, investigation and management of dementia in the elderly.
- Be able to Perform a mental state examination; this should include a 10-point Abridged mental test score (AMTS) and be familiar with the 30-point MoCA , the Montreal Cognitive Assessment test and the Addenbrookes Cognitive Examination (ACE-R).
- Know and understand the principles of assessment of mental competency / capacity.
- Know and understand the key therapeutic interventions used in patients with dementia (click to see list).
- Know and understand the function and role of the diagnostic memory clinic team and dementia support services
- Know and understand the principles of supporting patient's wishes who are losing or who are deemed not to have capacity including legal power of attorney and court of protection
- Appreciate the principles of multi-disciplinary, complex discharge planning for an older patient with cognitive impairment.
Lecture: Delirium
- The common causes of delirium under the following headings: Sepsis, Iatrogenesis, Intracranial, metabolic.
- Know and understand the roles of the key members of the multi-disciplinary team involved with the care of patients presenting with acute and chronic confusion.
- Know and understand the specific therapeutic interventions used in patients with common causes of delirium.
Lecture: Falls in Old People
- Be able to a focussed and diagnostic history of a patient presenting with falls
- Know the common causes of falls and instability in the older person
- Appreciate that most falls have a multi-factorial aetiology
- Be able to perform a focused, diagnostic examination of a patient presenting with a fall, including those presenting with a common fracture.
- Be able to order and interpret relevant investigations for a patient presenting with a fall, including common blood tests, radiology, microbiology,12-lead ECG and rhythm strips.
- Appreciate the multi-factorial approach that should be taken in falls prevention
Lecture: Polypharmacy
SLD + Minicase: Stroke
- The common causes and risk factors of TIA and stroke disease.
- The Oxford community stroke project classification of stroke.
- The objective ABCD2 score used in patients presenting with a TIA.
- Be able to take an appropriate, focussed history, and examine a patient presenting with TIA or stroke disease.
- The common differential diagnosis of patients presenting with TIA or stroke like symptoms.
- Know and understand how to investigate a patient presenting with TIA / Stroke disease including the ordering and interpretation of relevant (click to see list)
- Know and understand the primary drug classes and members used in TIA / Stroke disease, their indications, contra-indications, common side effects and interactions; Including anti-platelets, Thrombolysis, Anticoagulants, Lipid lowering medications, Smoking.
- Know and understand the roles of the key members of the multi-disciplinary team involved with the care of stroke patients.
- Appreciate the organisation of acute and rehabilitation services for stroke patients, including HASU, stroke units and community stroke team.
- Know and understand the common acute and long term complications of stroke, their diagnosis and management; Including nutrition, speech and language problems, skin care, secondary sepsis, loss of limb function, incontinence, depression.
- Appreciate the role of the specialist MDT in the rehabilitation and discharge planning for patients with severe disability.
SDL +Minicase: Tremor
- Know and understand the common causes of parkinsonism, including Primary Parkinson’s disease, Secondary – Vascular Parkinsonsm, Drugs, Neurodegenerative disorders (Parkinsonism plus group), Trauma and toxins
- Be able to take an appropriate, focused history, and examine a patient presenting with Parkinsonism
- Know and understand how to investigate a patient presenting with parkinsonism, including the ordering and interpretation of relevant (click to see list)
- Appreciate the use of functional radiological scanning including PET and SPECT scans.
- Appreciate the role of stereotactic neurosurgical interventions
- Know and understand the roles of the key members of the multi-disciplinary team involved with the care of patients presenting with Parkinson’s disease
- Know and understand the primary drug classes used to manage Parkinson’s disease including L-Dopa, DA agonists, COMT inhibitors, MAO-B inhibitors, Apomorphine
SDL + Minicase: Bones and Fractures
SDL: Pressure sores
- Be aware of the causes of pressure sores in the elderly patient and importance and impact this has on a patients health and prognosis.
- Be aware of the classification of pressure sores.
- Be aware of the waterlow score used to predict development of pressure sores and methods to prevent sores developing
- Be aware of management strategies around managing pressure sores.
SDL: Surgery in the elderly
- Be aware that it is comorbidities not age on its own that predicts outcome in the older surgical patient and that decisions should not be made on grounds of age alone.
- Appreciate the generic principles of working up a patient for a major operative intervention, including gaining consent (in patients with and without capacity), peri-operative care, anaesthetic assessment.
- Aware of the role of the geriatrician and multidisciplinary team in the management of the older surgical patient in particular hip fractures.
SDL: Disability, Rehab and Discharge planning
- The common causes and effects of severe disability in the older patient
- How to assess a patient’s level of ability / disability, including being able to assess previous and present level of activities of daily living (ADLs), their home circumstances and levels of support (formal and informal)
- The issues and their immediate management that arise when a severely disabled patient is admitted to hospital.
- The principles around complex discharge planning (click to see list)
- Appreciate the multi-disciplinary approach taken in a falls clinic.
- Appreciate the principles of simple and complex discharge planning for an older patient recovering after a fall
- Know and understand the principles of the post-operative rehabilitation of an older patient.
SDL: Non Classified Geriatric Topics
- Is able to describe the contributions of the following professions allied to medicine: Occupational therapy, Physiotherapy, Nurses, Dieticians, Speech & language therapists, Social workers.
- Is able to explain how these professions can work together effectively as part of a multidisciplinary team.
- Is able to define the interaction between health and social services in the provision of long-term care for older adults and describe the following services; NHS continuing care, residential home care, nursing home care, community care at home, community nursing care, community matron service, intermediate care at home, residential intermediate care, interim care.
- Advocates against ageism and recognise that it can affect the optimal care of older patients.
- Is able to describe the concept of rehabilitation (BGS)
SDL: Ethics and Law
- Advocates against ageism and recognise that it can affect the optimal care of older patients.
- Maintains a professional approach to the older person.
- Gives consideration to various myths and stereotypes related to older people.
- Recognises the heterogeneity of older persons and that each person needs to be viewed as an individual.
- Can describe the ethical and legal issues including: advance directives; euthanasia and assisted suicide; safeguarding; withdrawal and withholding of medical treatment; cardiopulmonary resuscitation decisions.
- Can describe the principles of autonomy, mental capacity to make decisions and the concept of Best Interests, Deprivation of Liberty Safeguards (DOLS).
- Can describe the legislation in each jurisdiction which outlines and protects these principles.
