Geriatrics

During this rotation, you will become familiar with the remarkable heterogeneity found among older persons with respect to physiologic function, health status, belief systems, values and personal preferences. 

You will learn to:

• understand the difference in presentation of disease in this population subgroup
• understand the importance of maintaining functional independence in elderly patients
• appreciate the fine balance of patient observation, judicious diagnostic intervention and acceptance of limits as defined by the geriatric patient
• understand that effective management of geriatric problems necessitates an interdisciplinary team approach

Specific goals of the rotation are to ensure you gain competence in each of the following core competencies:

Acquire knowledge in common geriatric syndromes:

• falls
• pressure ulcers
• polypharmacy
• delirium
• depression
• dementia
• malnutrition/failure to thrive
• urinary incontinence

Learn how to improve transitions of care (medication reconciliation, accurate and detailed discharge summaries, interdisciplinary team management, and optimized hospital-skilled nursing facility communication).

Learn the geriatrician approach to the diagnosis, evaluation, and treatment of common medical illnesses:

• pneumonia
• aspiration pneumonia
• congestive heart failure
• urinary tract infections
•  soft tissue infections
• wound care
• constipation/fecal impaction
• falls
• syncope

1. Information gathering: The clinical skill of data collection including history-taking from the patient as well as obtaining collateral information, physical examination and the appropriate request of laboratory and imaging studies appropriate to care setting.
2. Synthesis of treatment plan: The ability to formulate appropriate differential diagnoses and therapeutic plans based on an ability to critically analyze the clinical data, and integrate this analysis with the basic fund of medical knowledge.
3. Learn how to orchestrate the care of older adults with multiple comorbidities.

You will be able to demonstrate clinical competence in a variety of settings including extended care facilities, outpatient clinics, palliative care settings, and in patient’s home. You will become familiar with utilizing visiting nurse services for the care of homebound patients and other supportive services in the community.

Observation of one 3-hour cognitive evaluation (neuropsychological assessment) for an older adult veteran (age 65 or older). Observation includes both testing and clinical interview. Clinical interview often includes a collateral informant (family member, close friend) in addition to the patient.

Charts are reviewed beforehand and the case is discussed. After the patient leaves, there is also typically some review of the tests that were administered, some of the scoring, and discussion of impressions of the case.

You will work closely with nutritionists, social workers, hospice staff and other professionals to coordinate interdisciplinary care, a key component of managing these patients’ health.

PGY-4

4 weeks

ADHC (Adult Day Health Care) and GEM (Geriatric Evaluation and Management)
3131 Sheridan Dr., Suite 103
Amherst, NY 14226

CLC (Community Living Center)
222 Richmond Ave.
Batavia, NY 14020
(take shuttle from Buffalo VAMC to Buffalo VAMC. Main building, Room 201, near elevator)

Geropsychology Assessments
VA Medical Center
3495 Bailey Ave.
Buffalo, NY 14215
(Main Building, Room 201, near elevator)

HBPC (Home Based Primary Care)
222 Richmond Ave.
Batavia, NY 14020
(Building 3, second floor)

• Majortiy of patients are males, 65 and older and are veterans