Intern Geriatrics Rotation Orientation

2012-2013

•  "I had to wait 110 years to become famous.  I wanted to enjoy it as long as possible."  Jeanne Louise Calment  (1875-1997)

• The oldest documented living human, this French woman had all her wits about her when she reached the age of 110… she lived to 122.

Rotation Core ConceptsTYPICAL RESIDENT ROTATION GERIATRICS & PALLIATIVE CARE

MD “silo” Interdisciplinary teamwork

Single site of care per rotation Transitions of care

Disease-focused management Symptom-focused management

Assessment based on diagnoses only Functional assessment

Patient alone Patient, family, caregivers

Age-based cutoffs Remaining life expectancy

Disease-based syndromes Geriatric syndromes

Multiple sites of Care

• Ambulatory Clinic• Inpatient Geriatrics & Palliative Care Consults• Horizon Hospice home visits• Specialty clinics• Nursing home & subacute rehab

Multiple Sites of Care

• Learning Objectives• Logistics

Outpatient Senior Health Center at South Shore

• Primary care geriatrics clinic for pts 65 and older

• Evaluate ambulatory patients with geriatrics attending

• Focus on: functional and cognitive assessment

• Learning Objectives:– Perform a functional assessment on an ambulatory older

adult.– Perform a falls screen on an ambulatory older adult.– Perform screening for urinary incontinence on an

ambulatory older adult.– Perform cognitive screening on an ambulatory older adult.– Practice incorporating remaining life expectancy and patient preferences into screening and treatment decisions.

– Practice patient education in patients with low health literacy and/or impaired cognition.

– Perform a medication review in an older adult patient

Outpatient Senior Health Center at South Shore

• Logistics:– Contact: Individual provider based on schedule– Location: Outpatient Senior Health Center at

South Shore (7101 S. Exchange Ave.). Secure parking lot is just down the street, pull up to the clinic and ask for the gate opener at the front desk when you arrive, then park your car.

– Hours: 8 AM for morning clinics, 1 PM for afternoon clinics, unless otherwise noted on schedule

Outpatient Senior Health Center at South Shore

Inpatient Palliative Care & Geriatrics Consults

• Learning Objectives:– Participate in a family meeting to address goals of

care.– Assess pain and develop an initial treatment plan.– Assess non-pain symptoms and develop an initial

treatment plan.

• Logistics:– Contact: Bansari Patel, APN at pager 9052– Location: Inpatient wards– Hours: 8AM-5PM M-F

Inpatient Palliative Care & Geriatrics Consults

Horizon Hospice: Home visits

• Learning Objectives:– List eligibility requirements for the Medicare Hospice

Benefit– List the covered services of the Medicare Hospice Benefit– Identify disease specific factors indicating a prognosis of

less than 6 months for the common hospice diagnoses: cancer, dementia, chf

– Describe the role of each member of the hospice interdisciplinary team

Horizon Hospice

• Logistics:– Meet Dr. Malec (pager 4809) at U of C (W700) on

day of home visits

Nursing Home/Subacute Rehab• Learning Objectives:– Describe how care in the nursing home setting

differs from acute hospital care and outpatient care

– Describe how subacute rehabilitation and long-term custodial care in the nursing home is financed

– List potential sources of medical error that occur during care transitions from hospital to nursing home

• Logistics:– Contact: Dr. Brauner (p7222) or Dr. Limaye

(p3103)– Location: • Renaissance South Shore (7101 S. Exchange avenue,

behind South Shore clinic) • Montgomery Place (5550 South Shore Drive)

– Hours: variable based on individual schedules

Nursing Home/Subacute Rehab

• Memory Center• SOCARE• SAFE• Physical Therapy

Specialty Clinics

Specialty Clinics

LEARNING OBJECTIVES:• Memory Center:

– Describe the spectrum of memory changes that occur with aging from normal decline to mild cognitive impairment to dementia syndromes.

– Perform cognitive screening test and interpret results• SOCARE

– Work with an interdisciplinary team to assess and manage complex older adults with malignancies.

– Perform a functional assessment on an older adult with cancer• SAFE

– Work with an interdisciplinary team to assess and manage complex older adults with frailty

– Perform a functional assessment on an older adult with frailty• Physical Therapy

– Observe a balance/gait/fall risk assessment– Appreciate the role of physical therapy in the care of older adults

LOGISTICS• Contact:

– Memory Center: Dr. Shega (p5624) or Dr. Williams (p4833)– SOCARE: Dr. Dale (p3873)– SAFE: Dr. Rush (p5560) or Dr. Thompson (p1396)– Physical Therapy: Jennifer Gilbertson (p2512) or Roger Fong (p4016)

• Location:– Memory Center: South Shore Clinic (7101 S. Exchange Ave.)– SOCARE: DCAM 6D– SAFE: South Shore Clinic (7101 S. Exchange Ave.)– Physical Therapy: W107

• Hours:– Memory Center: Mondays 8AM– SOCARE: Fridays 7:30 AM– SAFE: Wednesdays 12:30 PM– Physical Therapy: Fridays 1 PM

Specialty Clinics

Assignments

• Independent learning• Documentation & record-keeping

Assignments

• 1.) Journal club• 2.) Interprofessional team write-up• 3.) Hopkins module• 4.) mini-CEXs

Journal club

• Identify clinical question from rotation (any care site)

• Perform & describe lit search for article that may answer clinical question

• Analyze quality of article using JAMA user’s guides format

• Present work to group• Evaluation part of residency EPA portfolio

Interprofessional team write-up

• 1.) During rotation, observe roles of interprofessional team members (APN, SW, PT, etc.)

• 2.) Describe interprofessional team encounter.– How did the team member contribute to the

patient’s care? – Describe how this type of team member may

contribute to patient care in your future career• 3.) Included in residency EPA portfolio

Hopkins module

• Complete Hopkins internet learning center module on Dementia by end of rotation

• www.hopkinsilc.org

Mini-CEX

• During outpatient clinic, practice geriatric exam, assessment, or counseling skills and receive clinic preceptor feedback

• Required to complete 6 mini-CEX during intern year… do them during this rotation & get them out of the way!

Mini-CEX topics

• Cognitive assessment• Falls• Health literacy & patient education• Medication review• Remaining Life Expectancy• Urinary Incontinence