A 3 Week Geriatric Education Program for 4th Year Medical Students at Dalhousie University

Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings. Results - The curriculum was successfully implemented. An examination, held at the end of each 3-week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program. Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly populatio

Surgical assessment of the geriatric oncology patient

BACKGROUND: The aging population in the United States will correlate with an increased number of cancer diagnoses as cancer is primarily a disease of the elderly. Providing this ever-growing group of individuals with quality surgical management, while taking into account the unique needs and desires of this cohort, is a great challenge facing both geriatricians and surgeons going forward. The best approach to ensure that oncogeriatric patients receive the best tailored treatment is through the completion of a pre-surgical geriatric assessment. However, only a minority of oncogeriatric patients is undergoing a comprehensive pre-surgical geriatric assessment despite the majority of geriatricians and surgeons acknowledging its importance in order to properly risk stratify their patients. LITERATURE REVIEW FINDINGS: Multiple theories exist as to why geriatric assessments are not being utilized more frequently, but the most probable answer is that these assessments are very time-consuming, making it virtually impossible for incorporation into a healthcare provider’s busy schedule. Comprehensive literature review regarding geriatric assessments amongst the oncogeriatric population found that the most sensitive and specific domains of the geriatric assessments predicting morbidity and mortality include Frailty Index, Social Support Survey, Mini-Nutritional Assessment, and Geriatric Depression Screening. PROPOSED METHODS: A novel educational intervention will be proposed to teach Physician Assistant and Medical Students about the domains of the geriatric assessment most predictive of post-surgical risk during their surgical clerkship. The curriculum will utilize both simulation- and competency-based education training under the guidance of geriatricians and surgeons. Students will first learn the necessary skills in a controlled classroom environment and then proceed to incorporate these skills during their clerkship with patients on their service. CONCLUSIONS: The goal of the proposed method is to instill the confidence and skills necessary to provide an accurate geriatric assessment for oncogeriatric patients in future clinicians. The field of geriatric oncology is going to grow exponentially in the up-coming years and familiarizing future clinicians with the most predictive domains regarding surgical outcome will improve treatment outcomes for oncogeriatric patients in the immediate and foreseeable future

An Educational Pathway for Geriatric Home Caregivers

The establishment of a multi-tiered educational pathway for geriatric home caregivers would support efforts to meet the needs of an increasing number of community dwelling older adults who require assistance with activities of daily living, while generating a cadre of qualified employees for an expanding non-medical private home care market. An educational pathway for geriatric home caregivers would also standardize the training of home care assistants while providing these individuals access to routine, high quality continuing education opportunities and the potential for career advancement. This issue brief provides two model educational pathways toward becoming a Geriatric Home Caregiver

Shared geriatric mental health care in a rural community

Introduction: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. Methods: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. Results: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. Conclusion: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated

Polypharmacy and potentially inappropriate medication use in geriatric oncology.

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. There is a great need to create standardized interventions to improve polypharmacy in geriatrics, and particularly in geriatric oncology. The process of deprescribing is aimed at reducing medications for which real or potential harm outweighs benefit, and there are numerous methods to determine which medications are candidates for deprescribing. However, deprescribing approaches have not been evaluated in older patients with cancer. Ultimately, methods to identify polypharmacy will need to be clearly defined and validated, and interventions to improve medication use will need to be based on clearly defined and standardized methods

Association of Physical Activity with Co-morbid Conditions in Geriatric Population

To find out association of physical activity with co-morbid conditions in geriatric population, a cross-sectional study was conducted in different cties of Pakistan in 2015. A total of 114 participants were inducted by non-probability convenience sampling technique. Data was collected after informed verbal consent by a validated questionnaire that is Rapid Assessment of Physical Activity (RAPA). Participants were categorized into two groups i.e. physically active and physically inactive. Data was entered and analyzed in SPSS version 20. There were 66 (57.9%) males and 48 (42.1%) females with mean age of 57.04±7.348 years. Among hypertensive individuals (n=43, 37.7%) there were 39 (90.7%) physically inactive, among individuals having angina (n=17, 14.9%) there were 15 (88.2%) physically inactive. Out of 37 (32.5%) diabetics, 35 (94.6%) were physically inactive. Among individuals suffering from arthritis (n=40, 35.1%), there were 38 (95%) physically inactive. A significant association was found between physical activity and diabetes and arthritis with p-value of 0.048 and 0.029 respectively. Physical activity is significantly associated with diabetes and arthritis in geriatric population. Adequate physical activity should be performed to reduce the risk of co-morbid conditions and improve the quality of life in geriatric population

Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life : study protocol for a phase 3 cluster randomized controlled trial

Background: The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life. Methods and design: A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life. Discussion: This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care