Geriatrics/Palliative Care Learning Objectives
Author: Rebecca Mazurkiewicz, MD
Editor: Lauren Peccoralo, MD
I.
General Learning Objectives
A. Clinical Skills Learning Objectives
1. Recognize that common medical conditions may present
atypically in elderly patients.
2. Be able to recognize delirium and differentiate it
from dementia.
3. Be able to order/perform the tests that should be
included in the urgent work up of delirium and initiate early treatment.
4. Understand the morbidity/mortality associated with
delirium.
5. Perform a cognitive assessment of a patient
suspected of having dementia.
6. Identify patients with difficulty performing their
ADLs and IADLS as “at risk” patients.
7. Identify and be able to perform a brief physical
functional assessment in a geriatric patient to identify risk for falls.
8. Recognize the morbidity and mortality associated
with hip fractures in the elderly.
9. Be capable of determining if a patient has capacity.
10. Thoroughly manage common symptoms in patients with
advanced disease.
B. Interpersonal Skills Learning Objectives
1. Be capable of conducting a family meeting.
2. Name the different topics that can be addressed
during a goals-of-care discussion, including resuscitation, intubation,
hospitalization, artificial nutrition and hydration, and antibiotics and who is
allowed to refuse these things in the State of New York.
3. Recognize that goals of care can be situational and
so should be continually readdressed with patients and their families. In addition, a DNR order does NOT mean
“Do Not Treat.”
4. Recognize when to refer a patient to hospice and
present hospice as a positive treatment option for a patient with advanced
disease.
*Intern focused
Topics
II.
Medical Knowledge Learning Objectives
A. Dementia
1. *Define dementia and differentiate it from delirium.
2. Name the risk factors, screening tests, and
behavioral and pharmacological treatments of Alzheimer’s dementia, the most
common type of dementia.
3. *List other medical disorders that can commonly be
confused for dementia and the tests used to rule them out.
4. Readings
a.
Fleming, K.C.,
Adams, A.C., & Petersen, R.C.
Dementia: Diagnosis and Evaluation. Mayo Clinic Proceedings. 1995; 70: 1093-1107.
http://mayoclinproc.highwire.org/content/70/11/1093.abstract
b.
Grossberg, G.T.
& Desai, A.K. Management of
Alzheimer’s Disease. Journal of
Gerontology. 2003; 58:
331-353.
http://biomed.gerontologyjournals.org/cgi/reprint/58/4/M331
c.
Inouye,
S.K. Delirium in Older
Persons. NEJM. 2006; 354: 1157-1165.
http://eresources.library.mssm.edu:2368/cgi/content/full/354/11/1157
B. Delirium
1. *Name environmental and medical causes of delirium
and how to prevent them.
2. *Name the non-pharmacological and pharmacological
treatments of delirium and their common side effects.
3. Readings
a. Cole, M.G.
Delirium in Elderly Patients.
American Journal of Geriatric Psychiatry. 2004; 12: 7-21.
b. Inouye, S.K., et al. A Multicomponent Intervention
to Prevent
Delirium
in Hospitalized Older Patients. NEJM. 1999; 340: 669-676.
http://eresources.library.mssm.edu:2368/cgi/content/full/340/9/669
c. Young, J. & Inouye, S.K. Delirium in Older People. BMJ. 2007; 334: 842-846.
http://eresources.library.mssm.edu:2789/cgi/reprint/334/7598/842
C. Hip Fractures
1. *Given the morbidity/mortality associated with hip fractures in elderly patients, name ways to prevent these falls.
2.
Name the different forms of
anti-coagulation and their recommended duration of use after surgical therapy
for hip fractures.
3.
Readings
a.
Bequpre, L.et
al. Best Practices for Elderly Hip Fracture Patients. Journal of General Internal Medicine. 2005; 20: 1019-1025.
http://eresources.library.mssm.edu:2292/content/92538r7167707602/fulltext.pdf
b.
Huddleston,
J.M. & Whitford, K.J. Medical
Care of Elderly Patients with Hip Fractures. Mayo Clinic Proceedings. 2001; 76: 295-298.
http://mayoclinproc.highwire.org/content/76/3/295.abstract
c.
Tinetti,
M.E. Preventing Falls in Elderly
Persons. NEJM. 2003;
348: 42-49.
http://eresources.library.mssm.edu:2368/cgi/content/full/348/1/42
D. Enteral Feeding
1. *List
the indications for enteral feeding.
2. List
the various methods of enteral feeding and the complications associated
with each.
3. Readings
a. Drickamer, M.A. & Cooney, Jr.,
L.M. A Geriatrician’s Guide to
Enteral
Feeding. Journal of the American Geriatrics
Society. 1993; 41: 672-679. No online link available.
b. Dy, S.M.
Enteral and Parenteral Nutrition in Terminally Ill Cancer
Patients:
A Review of the Literature. American
Journal of Hospice & Palliative Medicine. 2006; 23: 369-377.
http://eresources.library.mssm.edu:6519/cgi/reprint/23/5/369
c. Finucane,
T.F., Christmas, C., & Travis, T.
Tube Feeding in Patients with Advanced Dementia. JAMA. 1999; 282: 1365-1370.
E. Ethics
1. *Define
capacity and the components necessary for a patient to have capacity.
2. *Define
informed consent and name the situations in which the need for
informed consent can be
waived.
3. *Define
confidentiality and name the situations in which the need for
confidentiality
can be waived.
4. Readings
a. Dubler,
Nancy. Ethics Paragraphs from MACE Fellows Curriculum
Articles.
Mount Sinai School of Medicine. July 2008.
No online link available.
F. Advance Care Planning
1. *Define the term surrogate and
distinguish this from a health care proxy in
terms of
the difference in scope of decision making for the State of New York.
2. Define
the terms advance directives and living wills.
3. Name common symptoms in patients with
advanced disease and how to manage
them.
4. Readings
a. Gillick,
M.R. Advance Care Planning. NEJM. 2004; 350: 7-8.
http://eresources.library.mssm.edu:2368/cgi/content/full/350/1/7
b. Lo, Bernard.
Advance Care Planning. The
American Journal of Geriatric Cardiology. 2004; 13: 316-320.
http://eresources.library.mssm.edu:2097/cgi-bin/fulltext/118800953/PDFSTART
c. Morrison, R.S. & Meier, D.E. Palliative Care. NEJM. 2004; 350: 2582-2590.
http://eresources.library.mssm.edu:2368/cgi/content/full/350/25/2582
G. Hospice
1. *Define
hospice and name its objectives.
2. List
the requirements for admission to hospice.
3. List
the services included in hospice care.
4. Readings
a. Brumley,
R et al. Increased Satisfaction
with Care and Lower Costs:
Results of a Randomized Trial of In-Home
Palliative Care. Journal of
the
American Geriatrics Society. 2007; 55: 993-1000.
http://eresources.library.mssm.edu:2097/cgi-
bin/fulltext/117995898/PDFSTART
b. Gazelle, G.
Understanding Hospice – An Underutilized Option for
Life’s Final Chapter. NEJM.
2007; 357: 321-324.
http://eresources.library.mssm.edu:2368/cgi/content/full/357/4/321
c. Morrison, R.S. & Meier, D.E. Palliative Care. NEJM. 2004; 350: 2582-2590.
http://eresources.library.mssm.edu:2368/cgi/content/full/350/25/2582
d. Wright, A.A. & Katz, I.T. Letting Go of the Rope – Aggressive Treatment, Hospice Care, and Open Access. NEJM. 2007; 357: 324-327.
http://eresources.library.mssm.edu:2368/cgi/content/full/357/4/324