Tufts OpenCourseware
Search

Objectives

  • Able to place clinical medicine and the patients it serves in their proper biologic, economic and social context.
  • Able to identify the population-based determinants of health and describe how they interact to predispose patients to a range of health outcomes.
  • Able to distinguish between clinical approaches that target the same health outcomes.
  • Able to use preventive medicine to illustrate the clinical application of population medicine.
  • Able to illustrate how population medicine can be applied to clinical practice using the elderly as a potentially vulnerable population.
  • Able to demonstrate the attitudes and skills necessary to professionally interact with elderly individuals in their places of residence and develop a clinical plan to intervene on their behalf.
  • Able to propose realistic strategies for solving complex clinical problems in geriatrics using both population and clinical interventions.

1. Course Schedule

Session

Topic

1

Population Medicine

2A / 2B

Aging in America / Successful Aging

3

The Geriatric Assessment

4A / 4B

Geriatric Syndromes / Aging and Longevity

5A / 5B

The End of Life / Faith

6

Field Experience I

7

Field Experience II

2. Student Responsibilities

To pass this course, you will need to:

  1. Attend both field experiences in their entirety.

  2. Complete and submit Parts 1 and 2 of the Directed Geriatric Assessment (DGA) If you work with a partner for this exercise, the two of you should submit one copy of both parts, for which you will receive one score.

  3. Submit your Population-based Intervention Plan (PIP). You must submit your own PIP even if you worked with a partner on the DGA.

    Directed Geriatric Assessment Overview

3. Directed Geriatric Assessment Overview

An essential feature of any effective geriatric assessment is its adaptability to different situations. As the name implies, the Directed Geriatric Assessment (DGA) is a focused package of assessment components that best fit a given set of clinical circumstances. We have developed the DGA to meet your needs as medical students visiting elders in their place of residence for the first time. Unlike multidisciplinary assessments performed over many sequential encounters, this one is brief, straightforward, innocuous and, at times, inappropriate for your particular patient. As you know, elders are a heterogeneous group and not all of the questions and examinations are pertinent to your particular patient and his or her circumstances.

3.1. The Field Experiences

3.1.1. Learning Objectives

Your objectives for the geriatric assessment experience focus less on knowledge and more on the attitudes and skills necessary to care competently and compassionately for the elderly. Although an extensive knowledge base is critical, it is overly ambitious to expect you to achieve any particular level of knowledge in this short course.

Attitudes

By the conclusion of the site visits, you will:

  • Be aware of the various myths and stereotypes related to older people.

  • Recognize that ageism, like racism, can be found in all aspects of society, including the health professions, and can adversely affect the care of the elderly patients.

  • Be mindful of the heterogeneity of the geriatric population--a diverse group with different personalities, values, functional levels, and medical problems.

  • Realize that geriatric care is a multidisciplinary effort requiring you to work with colleagues in other fields if you are to successfully care for older adults.

  • Recognize the difficulties that caregivers face attending to the needs of their older, frail family members.

  • Appreciate the importance of optimizing function rather than just treating disease.

  • Become aware of your own attitudes towards your own aging, disability, and death.

3.1.2. Skills

By the conclusion of the site visits, you should be proficient in:

  • Performing a directed geriatric medical history including a pain assessment.

  • Performing a nutritional and social assessment.

  • Performing selected components of the physical exam, including vital signs, gross visual and auditory screening, and mobility evaluation.

  • Performing a neuropsychiatric evaluation, including cognition and mood.

  • Performing a functional evaluation.

  • Developing a brief problem list and intervention plan.

3.1.3. Logistics

The site visits will occur on two days, three hours each day. You and up to 11 other students will be assigned to an elder care facility where you will meet your preceptor and a representative from the site. You'll need to reach the site on your own (most are accessible by public transportation), and it is imperative that you arrive on time for both sessions. Be sure to dress appropriately (professional attire for seeing patients), and bring your name tag identifying you as a medical student. White coats are optional.

3.2. The Assessments

Immediately following the introductory talk, you will choose a partner and meet a prearranged resident or patient willing to work with you. Use the DGA to perform your assessment in two parts.

During Session 1 , obtain the medical, nutritional and social histories. Save Session 2 for the neuropsychiatric, functional and physical examination. Although we cannot guarantee it, you are supposed to have access to the same patient both times, so please be sure to record the name of your resident and plan to meet with him or her the following week.

In the unlikely even that you finish Session 1 early, do not proceed with the Session 2 portion of the assessment on the first day. Since some residents will tire sooner than others, a number of you may return to unfinished parts of Session 1 if the resident is willing. It is unlikely, however, that most residents will last much longer than an hour. Please remain sensitive to the restriction.

If you are unable to complete a portion of the assessment, be sure to provide a brief explanation (e.g.: patient refused, could not recall, or was non-ambulatory) in the Unable to Complete section at the end of each part of the DGA.

Group Discussions

After about an hour, you will reconvene with your preceptor in a designated location (most likely where you met for the introductory talk). The purpose of the group discussion is to give you the opportunity to share your experiences, assimilate your findings, and create a problem list. Take a few minutes before the discussion to sit down with your partner and develop a list of problems, based on your assessment, that you feel your patient's caregivers should keep in mind. Use the DGA grid to organize your thoughts. During Session I, you and your preceptor will arrive at a mutually acceptable way to conduct the group discussions.

Your Responsibilities

  • Attend both sessions and arrive on time. Your preceptor will document your attendance at each session. Remember, if you are unable to attend either session, you must contact the course director prior to the day of the session. In case of emergency, you must notify the course director within 24 hours of the scheduled session.

  • Submit both parts of a completed legible Directed Geriatric Assessment (DGA) and your typewritten Population Intervention Plan (PIP). Be sure to place your name on all documents. If you worked with a partner for this exercise, the two of you should submit one copy of both parts of the DGA, for which you will receive one score. However, each of you must submit your own PIP for which you will receive separate scores. Please do not give your completed DGA or anything else (except your thanks) to your preceptor.

DGA Evaluation

Both parts of the DGA are worth a combined maximum of 6 points. They will be evaluated using the following criteria:

  • Legibility. Plan to transfer all handwritten data from your initial encounters to a fresh typewritten DGA for submission.

  • Completeness. Although you may find that you were unable to complete certain sections of the DGA for various reasons, it's essential that you account for any missing data by providing an explanation in the Unable to Complete sections at the end of each form.

  • Problem Lists. These are the most important part of the geriatric assessment. Since the health of the residents you work with will vary considerably, there is no minimum number of problems you need to document. However, each subsection should include at least one entry. The thoroughness of your intervention plan for each problem in your list is a key component of the DGA evaluation.

Field Experience Preparation

Carefully review the Comprehensive Geriatric Assessment from Session 3. Although you will not be performing a comprehensive assessment, you will need this background information to successfully use the DGA instrument. Then study the part of the DGA you will be doing in the upcoming session. Be sure to bring a copy of the DGA to your site for both sessions. Your preceptor will not have extra copies.

For Session 2, you will also need to bring along the following equipment:

  • Blood pressure cuff

  • Stethoscope

  • Jaeger hand-held eye chart

  • Ophthalmoscope

  • Otoscope

4. Grading Policy

This is an honors/pass/fail course. You will not receive a final grade until the end of Part 2 of the course. You may earn a total of 20 points for the entire course. The work you do in the first semester is worth 60% of the two semester course.