The Portal of Geriatrics Online Education

Caring Across the Continuum: Mrs. Porter Age 88


Caring Across the Continuum: Mrs. Porter Age 88

University of Texas Medical School at Houston
Jennifer Larson, MD, Kathleen Pace Murphy, MD, Sharon Ostwald, MD, Linh Nguyen, MD
Donald W. Reynolds Foundation
POGOe Id: 
Date Posted: 
Date Reviewed/Updated for Clinical Accuracy: 

Caring Across the Continuum: An Aging Virtual Patient Series. Case Four: Mrs. Porter Age 88 - Introduction to Palliative Care. This case, the fourth in a four-part series about the virtual patient, Mrs. Porter, introduces the learner to palliative care and hospice concepts and is set in an Acute Care for the Elderly (ACE) Unit.  Mrs. Porter has become less mobile, weak and is depressed. She has become more confused and has unintentionally lost 12 pounds since her last visit with Dr. Pat three months ago. Concepts included in this case are conducting a functional and nutritional assessment; setting goals of care; conducting a family conference; discussing Do Not Resuscitate (DNR) orders; discussing a hospice referral;  and, recognition of the interprofessional practitioners’ contributions to patient care.The case concludes with a home hospice care order for Mrs. Porter. The learner is asked to write a discharge summary for Geriatric Failure to Thrive, taking into account all the details in the case example of Mrs. Porter's family meeting with the interprofessional team.

Educational objectives: 

On completion of Case Four: Mrs. Porter Age 88, students will be able to:

  1. Recognize the clinical presentation of malnutrition
  2. Identify common contributing factors of malnutrition in older adults
  3. Define palliative care
  4. Identify at least three characteristics of palliative care
  5. Define general hospice criteria and criteria for failure to thrive/debility
  6. Demonstrate the ability to express the relative risks and benefits of treatment options
  7. Identify the key steps in conducting a family meeting;
  8. Describe strategies for working with families when there is disagreement or indecision
  9. Document a complete summary of the family conference
Additional information/Special implementation requirements or guidelines: 

This product is one part of a short series consisting of the following products:

As an innovative, virtual learning series, this web-based series of cases spans the 21-year relationship of care between geriatrician Dr. Patricia Thompson and her patient, Mrs. Alice Porter. This virtual learning experience for medical students, based on the Association of American Medical Colleges (AAMC) competencies, is designed to pique interest and enhance knowledge and skills in the care of older adults. The web-based learning environment provides students the unique opportunity to observe and interact with Mrs. Porter, in an ongoing doctor-patient relationship, outside of the traditional classroom setting. The series exposes students to the importance of continuity of patient care, since each case correlates to a different year of medical school education. As the medical student advances in their curriculum, Mrs. Porter continues to age, requiring more complex care and further application of critical thinking skills from the student. Each case has a unique focus that targets key geriatric and/or palliative concepts appropriate to the level of the student that can easily be embedded into existing medical school courses.

The virtual cases allow students to explore approaches to the patient; observe model clinician-patient interactions; choose practice techniques; offer health promotion, palliative counseling, and patient counseling; and contemplate complex ethical decisions regarding the care of the patient in an innocuous, self-paced, virtual environment. The embedded natural language system in each case offers an opportunity to pose real-world questions and problems to the learner, with the goal of eliciting critical thinking skills and reflective learning.

The series offers a readily available complementary assignment to the classroom and clinical experience. The self-paced case studies contain video animation, an interactive electronic medical record, Geriatric Gems and Palliative Pearls, natural language style critical thinking, clinical reasoning and clinical judgment learning activities, and evidence-based expert explanations. Evaluative tools include a pre and post quiz and rubric-scored natural language short answer and essay questions. The natural language system provides hints to the students and evaluates their responses based on the information they provide. Student actions and choices are captured for formative evaluation, as well as to provide student feedback.

The virtual patient system is a web-based application that runs on Windows Server, running IIS with ASP enabled within IIS. The project database is Microsoft Access.

The first time you explore a case, you will need to register. There is a "Register" button at the bottom of the login form. Click this button to register or to have your password sent to the email address you entered when you registered.

On the popup registration form, you will need to enter an ID and a password. Your ID can be anything you wish. You can use the same User ID and password for any of the four cases. All of the other fields are optional. (The email field is optional. If you don't enter an email address when you register, the system can't send you your password and/or ID if you forget them.)

Intended learner audience: 
Estimated time to complete: 
1 hour
Conflict of Interest Disclosure: 
No, I (we) have nothing to disclose.
Contact Person/Corresponding Author:

Suggested Citation:
Dr Linh Nguyen, Jennifer Larson, Dr. Sharon Ostwald and Dr. Kathleen Pace Murphy. Caring Across the Continuum: Mrs. Porter Age 88. POGOe - Portal of Geriatrics Online Education; 2013 Available from: