Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 4 HCOE4: Health Care of the Elderly

• Dr Dhanupriya Sivapathasuntharam,
• DHANUPRIYA.SIVAPATHASUNTHARAM@bartshealth.nhs.uk

Teaching Material for this Module

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.

 

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Index

• General Outcomes for Healthcare of the Elderly
• Stroke and TIA's in the Elderly
• Delirium and Dementia in the Elderly
• Tremor in the Elderly
• Falls in the Elderly
• Fragile Bones and Fractures in the Elderly
• Surgery in the Elderly
• Disability, Rehabilitation and Discharge Planning
• End of Life Decisions, Death and Dying
• Incontinence in the elderly
• Elder abuse
• Pressure sores

• General Outcomes for Healthcare of the Elderly
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Physiology of Ageing - General
      1. Can describe the physiology of ageing (NB: British Geriatric Society Outcome).
      2. Know the difference between chronological, biological and functional age.
      3. Know the differences between normal ageing 'senescence' and common pathologies of old age.
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • Disease of Ageing - General Pathology
      1. Can describe the biochemical, molecular, cellular, genetic theories of ageing.
      2. Can describe the pathology associated with normal ageing and age associated disease processes.
      3. 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.
  • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Management of Disorders of the Elderly - General
      1. Able to describe the process of Comprehensive Geriatric Assessment (CGA) and list its main domains. Be able to formulate an acute and chronic problem list with individualised management plans.
  • Clinical skills: THERAPEUTIC PROCEDURES (TD 18 b)
    • General
      1. Is able to describe the concept of rehabilitation (BGS)
  • Clinical skills: PRESCRIBING DRUGS SAFELY AND EFFECTIVELY (TD 17 a-h)
    • Pharmacological Therapy for Elderly People
      1. Can describe the concepts of polypharmacy.
      2. Can describe the concepts of: the practice of safe prescribing in older adults, taking account of differing physiology, drug interactions and multiple pathologies.
      3. Can describe the effect of ageing upon pharmacodynamics and pharmacokinetics.
  • Professional issues: WORKING IN TEAMS (TD 22 a-c)
    • General Outcomes for Working in Teams
      1. Is able to describe the contributions of the following professions allied to medicine: Occupational therapy, Physiotherapy, Nurses, Dieticians, Speech & language therapists, Social workers.
      2. Is able to explain how these professions can work together effectively as part of a multidisciplinary team.
      3. Advocates against ageism and recognise that it can affect the optimal care of older patients.
      4. 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.
  • Professional issues: ETHICS and LAW (TD 20 a-g)
    • Legal, Moral, Ethical Responsibilities of Patient Care
      1. Maintains a professional approach to the older person.
      2. Gives consideration to various myths and stereotypes related to older people.
      3. Advocates against ageism and recognise that it can affect the optimal care of older patients.
      4. Recognises the heterogeneity of older persons and that each person needs to be viewed as an individual.
      5. Can describe the ethical and legal issues including: advance directives; euthanasia and assisted suicide; safeguarding; withdrawal and withholding of medical treatment; cardiopulmonary resuscitation decisions.
      6. Can describe the principles of autonomy, mental capacity to make decisions and the concept of Best Interests, Deprivation of Liberty Safeguards (DOLS).
      7. Can describe the legislation in each jurisdiction which outlines and protects these principles.
• Stroke and TIA's in the Elderly
  • General Topics
    1. The common causes and risk factors of TIA and stroke disease.
    2. The Oxford community stroke project classification of stroke.
    3. The objective ABCD2 score used in patients presenting with a TIA.
    4. Be able to take an appropriate, focussed history, and examine a patient presenting with TIA or stroke disease.
    5. The common differential diagnosis of patients presenting with TIA or stroke like symptoms.
    6. Know and understand how to investigate a patient presenting with TIA / Stroke disease including the ordering and interpretation of relevant (click to see list)
    7. 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.
    8. Know and understand the roles of the key members of the multi-disciplinary team involved with the care of stroke patients.
    9. Appreciate the organisation of acute and rehabilitation services for stroke patients, including HASU, stroke units and community stroke team.
    10. 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.
    11. Appreciate the role of the specialist MDT in the rehabilitation and discharge planning for patients with severe disability.
• Delirium and Dementia in the Elderly
  • Dementia in the Elderly
    1. Know the definition and differences between delirium and dementia.
    2. Be able to take an appropriate, focussed history, and examine a patient presenting with delirium and / or dementia.
    3. Know and understand how to investigate a patient presenting with delirium and /or dementia, including the ordering and interpretation of relevant tests.
    4. The common causes of delirium under the following headings: Sepsis, Iatrogenesis, Intracranial, metabolic.
    5. 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.
    6. Know and understand the specific therapeutic interventions used in patients with common causes of delirium.
    7. The common causes of dementia (click here for details).
    8. Describe the pathology, presentation, investigation and management of dementia in the elderly.
    9. 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).
    10. Know and understand the principles of assessment of mental competency / capacity.
    11. Know and understand the key therapeutic interventions used in patients with dementia (click to see list).
    12. Know and understand the function and role of the diagnostic memory clinic team and dementia support services
    13. 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
    14. Appreciate the principles of multi-disciplinary, complex discharge planning for an older patient with cognitive impairment.
• Tremor in the Elderly
  • Parkinson's Disease
    1. 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
    2. Be able to take an appropriate, focused history, and examine a patient presenting with Parkinsonism
    3. Know and understand how to investigate a patient presenting with parkinsonism, including the ordering and interpretation of relevant (click to see list)
    4. Appreciate the use of functional radiological scanning including PET and SPECT scans.
    5. Appreciate the role of stereotactic neurosurgical interventions
    6. 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
    7. Know and understand the primary drug classes used to manage Parkinson’s disease including L-Dopa, DA agonists, COMT inhibitors, MAO-B inhibitors, Apomorphine
• Falls in the Elderly
  • General Topics
    1. Be able to a focussed and diagnostic history of a patient presenting with falls
    2. Know the common causes of falls and instability in the older person
    3. Appreciate that most falls have a multi-factorial aetiology
    4. Be able to perform a focused, diagnostic examination of a patient presenting with a fall, including those presenting with a common fracture.
    5. 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.
    6. Appreciate the multi-factorial approach that should be taken in falls prevention
    7. Appreciate the multi-disciplinary approach taken in a falls clinic.
    8. Appreciate the principles of simple and complex discharge planning for an older patient recovering after a fall
    9. Know and understand the principles of the post-operative rehabilitation of an older patient.
• Fragile Bones and Fractures in the Elderly
  • Osteoporosis in the Elderly
    1. The common causes and risk factors leading to osteoporosis
    2. The common presentations of patients with osteoporosis
    3. The common therapeutic interventions used in osteoporosis including calcium and vitamin D supplementation, Bisphosphonates, SERMs, Strontium, Parathyroid hormone analogues, Calcitonin
• Surgery in the Elderly
  • General Topics
    1. 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.
    2. 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.
    3. Aware of the role of the geriatrician and multidisciplinary team in the management of the older surgical patient in particular hip fractures.
• Disability, Rehabilitation and Discharge Planning
  • General Topics
    1. The common causes and effects of severe disability in the older patient
    2. The issues and their immediate management that arise when a severely disabled patient is admitted to hospital.
  • Rehabilitation
    1. 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)
  • Discharge Planning
    1. The principles around complex discharge planning (click to see list)
• End of Life Decisions, Death and Dying
  • General Topics
    1. Know and understand common, serious conditions that cause older patients to present in extremis (click to see list).
    2. Know and understand the principles of discharge planning for patients with end stage disease and / or multiple palliative care needs.
    3. Appreciate the principles used to discuss the diagnosis, progression and terminal care of patients with a neurodegenerative disease e.g. dementia.
    4. Appreciate the palliative care principles used to in the management of patients at the end of life.
    5. Appreciate the principles used in discussing end of life care, CPR, and appropriateness of care with patients and carers.
    6. 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:
    7. Know and understand how to certify death, complete a death certificate and part 1 of a cremation form.
• Incontinence in the elderly
  • General topics
    1. Understanding of the scale of the problem and impact that incontinence has on the individual
    2. Be able to take a focussed and diagnostic history of a patient presenting with incontinence.
    3. Aware of the different types of incontinence including stress, urge, mixed, functional and overflow.
    4. Know and understand how to investigate and manage an elderly patient with incontinence
    5. Aware of the causes of faecal incontinence.
    6. Know and understand how to investigate and manage an elderly patient presenting with faecal incontinence.
• Elder abuse
  • General Topics
    1. Have an awareness of the issues of elder abuse
    2. Aware of the different types of abuse: financial, physical, emotional
    3. Aware of the process of addressing and escalating any identified abuse.
• Pressure sores
  • General topics
    1. Be aware of the causes of pressure sores in the elderly patient and importance and impact this has on a patients health and prognosis.
    2. Be aware of the classification of pressure sores.
    3. Be aware of the waterlow score used to predict development of pressure sores and methods to prevent sores developing
    4. Be aware of management strategies around managing pressure sores.

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