The Portal of Geriatrics Online Education

12 FBG: Ask about falls and intrepret tests

12. Ask all patients > 65 y.o., or their caregivers, about falls in the last year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings.

Office - Based Geriatrics Assessment

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person’s functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually performed when the medical provider identifies a potential problem with the older adult patient. This holistic evaluation includes nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment model has been studied in the home, inpatient and ambulatory care settings and there is evidence that it aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement.

Educational objectives: 
›Understand how to assess a new complex older patient in the office
›Understand the importance of overall function, including activities of daily living (ADL and IADL)
›Discuss validated tools for depression and cognitive assessment
›Discuss medication review
Date posted: 
Wed, 08/11/2021
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 05/07/2021
Contact Person/Corresponding Author:



Suggested Citation:
Office - Based Geriatrics Assessment. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/106

Simulation Curriculum for Geriatric Medicine Fellows

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
999
Abstract: 

This material consists of a suite of nine simulated clinical cases, divided into three separate sessions of three cases each, intended to be conducted in a simulation center with simulated patients.  Cases are designed to teach geriatric medicine fellows and other appropriate learners basic geriatric assessment skills (Session one), how to navigate difficult situations in long-term care (Session two), and high-level communication skills in palliative and end-of-life care (Session three).  Each case consists of a multi-page document outlining scripts for the learner as well as the roles (patient, family member, facility staff, etc) portrayed by actors, necessary props and supporting materials, and instructions for evaluating and debriefing the learner.  Also contained in each document are Entrustable Professional Activities (EPA), Curricular Milestones (CM), and Reporting Milestones (RM) relevant to the case.

Educational objectives: 

- Efficiently and effectively assess and manage common geriatric syndromes in a variety of clinical settings.

- Demonstrate the ability to navigate difficult communication scenarios in a long-term care environment, while providing leadership, mediating conflict between interdisciplinary team members and/or family members, and providing high quality care.

- Provide compassionsate, patient-centered care at the end of life, using high-level communication strategies.

Additional information/Special implementation requirements or guidelines: 

n/a

Publications from, presentations from, and/or citations to this product: 

None, though plans to present this at AGS/ADGAP in 2019.

Date posted: 
Mon, 11/12/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/08/2018
Contact Person/Corresponding Author:



Suggested Citation:
Simulation Curriculum for Geriatric Medicine Fellows. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/106

Where's the Fall Risk?

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

One in four older adults have a fall or fall-related injury every year. “Where’s the Fall Risk?” is an interactive educational game that allows learners to discuss falls prevention in the home environment and think of potential solutions. Learners will be in groups of 2-6 people and use the provided picture to circle the fall risk areas in the given amount of time. The teams will then present the total number of areas by room and propose solutions for each fall risk area. A point will be given for each circled area and solution. The discussion portion of the game provides learners the ability to identify and fix high fall risk areas in the home. 

 

Educational objectives: 
  1. Understand what aspects of the home environment are considered fall risks
  2. Think of creative solutions to fix these fall risk areas
  3. At the end of the game, be able to have an active discussion with patients regarding falls prevention in the home environment
Additional information/Special implementation requirements or guidelines: 
Materials:
The game is best played in a group setting with teams composed of about 2-6 people.
  • Diagram of the home environment (PowerPoint provided)
  • Pen/Marker to circle fall risk areas
  • Timer
  • White board to keep track of points
Instructions:
Please print the provided diagram of the home environment. Groups of 2-6 people with a minimum of 2 groups.
Identification Phase:
  1. Set timer for 2 minutes and provide groups with the home diagram
  2. Start timer and have groups circle areas in the home that are considered fall risks. Suggestion to groups: it is easier to go room by room
  3. Once time is up, set pens to the side.
Solution Phase:
  1. Set timer for 2 minutes and provide groups with a sheet of paper.
  2. Start timer and have groups discuss why they circled the area as a fall risk and think of a solution for the fall risk area (of note, groups may not use “get rid of the item” as a solution).
  3. Once time is up, set pens to the side.
Discussion Phase:
  1. On white board, create a grid with group names at the top and rooms on the side (“Outside”, “Living Room”, “Kitchen”, “Dining”, “Bedroom”, “Bathroom”)
    1. Depending on how much time you have, it may be faster to discuss some rooms together: Outside & Living Room, Kitchen & Dining, Bedroom & Bathroom
  2. Start the discussion by going from room to room. Each team will get 1 point if they can identify a fall risk area and provide a solution. Of note, this is a key opportunity to discuss and talk about these high fall risk areas. You may propose other solutions and open it up to discussion with other groups as well.
  3. The winning team has the most points at the end of the game. 
Date posted: 
Wed, 07/25/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 05/26/2018
Contact Person/Corresponding Author:



Suggested Citation:
Where's the Fall Risk?. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/106

Mobility Clinical Evaluation Exercise (Mini-CEX)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
1
Abstract: 

This mobility Clinical Evaluation Exercise (Mini-CEX) is designed to use with a learner during an actual patient encounter. The leaner first views the Center for Disease Control and Prevention (CDC) videos on the Timed Up and Go Test, 30 Second Chair Stand and 4 Stage Balance tests and handouts prior to the administration of the Mini-CEX. The teacher observes the learner during the patient encounter and completes the Mini-CEX. The teacher reviews the form with the learner and provides feedback of what skill was observed, partially observed, not observed, not applicable and comments about the encounter.

Educational objectives: 

Learners who are administered this mobility Mini-CEX will:

1)acquire knowedgle about various tests for mobiilty, strength and balance.

2)be observed assessing mobility during a patient encounter.

3)receive feedback about their communcation and professionalism skills in assessing mobility.

Date posted: 
Mon, 01/23/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/23/2017
Product Viewing Instructions: 
Learner views videos prior to Mini-CEX
Contact Person/Corresponding Author:



Suggested Citation:
Mobility Clinical Evaluation Exercise (Mini-CEX). POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/106

Interprofessional Geriatric Education and Training in Texas: Seniors Assisting in Geriatric Education - Interprofessional Team-Based Training, Assignments & Grading

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

The Seniors Assisting in Geriatric Education (SAGE) program consists of an educational curriculum and community based outreach program aimed at increasing student opportunities for early exposure to older adults and issues of geriatrics. The program strives to create meaningful relationships for the interprofessional teams of students while gaining knowledge about today’s senior population and their needs. The educational component involves health care profession students interacting with each other and their senior mentor through structured assignments delivered in the home environment.

Student teams are paired in groups of 3-4 healthcare profession students. The student teams are then matched with a community-dwelling senior who receives services from Meals on Wheels or a senior volunteer from the local community. The program includes 6 visits over a 2 year period providing students an opportunity to apply their classroom education in the context and care of an older adult. Students practice and demonstrate basic clinical skills; including taking histories, interviewing, conducting examinations and cognitive assessments, and advising clients on nutrition, home safety, community resources and advance care planning.     

Educational objectives: 
  • Health professions students will develop competency with older adults;
  • Strengthen health care students clinical applications of medical education through an Interprofessional team experience in the SAGE Program;
  • Health professions students learn from each other and appreciate each others professions.
Publications from, presentations from, and/or citations to this product: 

SAGE Presentations

Marquez-Hall, S. (2015). Interprofessional practice: Seniors assisting in geriatric education. A round table presentation at the Interprofessional Practice Symposium, University of North Texas Health Science Center in Fort Worth, TX.

Marquez-Hall, S. Lane, Y. (2014) seniors assisting in geriatric education (SAGE): Reynolds program address the lack of training in geriatrics and provides a model for interprofessional education. Jefferson Center for Interprofessional Education Annual Conference, Jefferson Medical College, Philadelphia, PA.

SAGE Poster Presentations:

Marquez-Hall, S., Pitts-Lane, Y. Knebl, J., (2015). Seniors assisting in geriatric education (SAGE): Reynolds program addresses the lack of training in geriatrics and provides a model for interprofessional education. Poster presentation at Research Appreciation Day, University of North Texas Health Science Center, Fort Worth, TX.

Marquez-Hall, S., Lane, Y., Smith, R. (2014) Survey of medical students in a geriatric training program. Poster presentation at the American Geriatric Society Annual Scientific Meeting, Baltimore, MD.

SAGE Awards:

2013 Mae Cora Peterson Senior Spirit Award in recognition of the Seniors Assisting in Geriatrics Education (SAGE) Program, Senior Citizens of Tarrant County, Texas.

2011 AACOM Excellence in Communications Award. Second Place - Best Community Service Program-Serving Fewer Than 1,000. SAGE Program; University of North Texas Health Science Center at Fort Worth, Texas College of Osteopathic Medicine.  

Date posted: 
Thu, 10/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Geriatric Education and Training in Texas: Seniors Assisting in Geriatric Education - Interprofessional Team-Based Training, Assignments & Grading. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

Family Medicine Resident and Geriatric Fellow Longitudinal Home Visit Curriculum

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

With an aging population, the need to train primary care residents and geriatric fellows in home-based care continues to grow. A needs assessment of family medicine residents and geriatric fellows' attitudes and knowledge was performed to guide a novel, longitudinal home care curriculum based out of a Home-Based Primary Care practice within the Family Medicine Center.

Fellows are assigned a panel of two home visit patients from the Family Medicine Center's Home-Based Primary Care practice. Fellows follow these patients monthly and manage their care between visits.  In today’s rapidly changing clinical environment, primary care physicains and geriatricians must be adapt at analyzing systems and processes they work under and making changes to improve patient care. A new home visit program is a natural venue for a specific, achievable quality improvement intervention with support from faculty, the Home Based Primary Care practice team and the Family Medicine Center Patient and Family Advisory Council. 

The longitudinal family medicine resident curriculum is based on graded autonomy and focused objectives for each level with the ultimate goal of residents feeling empowered to include home visits in their future practice. After home visit sessions, residents complete personal, written reflections after each visit to optimize learning and retention, as well as for giving a venue for processing potentially challenging situations. Sample reflections are included. Third-year residents facilitate an interdisciplinary case conference to address various social determinants of health, home safety issues and medication concerns. By residency graduation, residents will complete 10-14 home visits. 

 
Educational objectives: 
  1. Describe challenges and opportunities unique to patient care in the home environment.  
  2. Review medication use and adherence while identifying medications that are no longer effective, are duplicative or carry greater burden than benefit.  Identify medications that you would recommend stopping and create a schedule for stopping these medications.
  3. Develop and implement a safety plan to make the patient’s home environment safer.
  4. Develop a personal plan to integrate home visits into your future practice.

Fellow-specific objectives:

  1. Develop, document and manage patient- and family-centered care plans related to patient’s health conditions and expected trajectory with emphasis on personal goals of care in collaboration with an interprofessional health care team and community service providers.
  2. Implement a process improvement as part of the Home Based Primary Care team.  

 

Date posted: 
Wed, 10/19/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/19/2016
Contact Person/Corresponding Author:



Suggested Citation:
Family Medicine Resident and Geriatric Fellow Longitudinal Home Visit Curriculum. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

VirginiaGeriatrics.Org

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
2
Abstract: 

The VirginiaGeriatrics.Org website consists of 6 primary resources and a secondary list of resources for further research. These primary resources include a video archive of the geriatric grand round lecture series, interactive pre-clinical basic science geriatric case studies for medical students, more advanced geriatric case studies for clinical residents, a quick consult guide for geriatric consults, an "ask the expert" discussion resource, and various educational materials related to the Virginia Geriatrics Society Conference. Additionally, spread through the website are external educational resources to complement the core material. Finally, there are some resources for patients and families that may be interested in contacting clinics and/or geriatricians.

Educational objectives: 

Listed through 6 primary education sections (Grand Rounds, Med Student Materials, Resident Materials, Quick Consults, Ask the Expert, etc)

Date posted: 
Thu, 09/22/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/22/2016
Contact Person/Corresponding Author:



Suggested Citation:
VirginiaGeriatrics.Org. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

Interprofessional Geriatric Education and Training in Texas: Fall Risk Education & Assessment

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

Each year, one in every three adults ages 65 or older falls and 2 million are treated in emergency departments for fall-related injuries. The risk of falling increases with each decade of life. The long-term consequences of fall injuries, such as hip fractures and traumatic brain injuries (TBI), can impact the health and independence of older adults. However, falls are not necessarily an inevitable part of aging. In fact, many falls can be prevented. All healthcare professionals can take actions to protect older adults.

The University of North Texas Health Science Center (UNTSHC) Reynolds Interprofessional Geriatric Education and Training in Texas (IGET-IT) Program has developed a Fall Risk Assessment and Education module as part of the Interprofessional Communication Improvement Modules (ICIM) Elder Safety series. The ICIM Elder Safety modules were created in collaboration with the National Board of Osteopathic Medical Examiners (NBOME) and are supported, in part, by a grant from the Donald W. Reynolds Foundation. The goal of the Elder Safety ICIMs is to provide innovative and sustainable programs to improve the ability of physicians to work with other health disciplines in teams to provide better care for geriatric patients. The care of older adults can be very complex and studies have shown that a team approach can be most effective in leading to quality outcomes.

Educational objectives: 

Upon completion of this activity, participants will be able to:

  • Describe risk factors associated with falls in older adults using a comprehensive fall risk assessment.
  • Identify examination components to assess for fall risk.
  • Describe how neurocognitive features can contribute to the risk of falls.
  • Identify four essential tests to assess neurocognitive features.
  • Describe how sensory factors impact the risk of falls.
  • Identify exams to assess sensory factors.
  • Identify the prescription, nonprescription, nutritional supplements, and food/drug interactions that are most frequently associated with an increased fall risk.
  • Discuss polypharmacy and its impact on fall risk.
  • Examine the evidence behind nutritional supplements that may help reduce fractures from falls.
Publications from, presentations from, and/or citations to this product: 

Gimpel, J., & Dowling, D.J. (2014, August). Watch Your Step: An Osteopathic Approach to Patient Fall Prevention and Intervention. Presented at the Pennsylvania Osteopathic Family Physicians Society Annual Convention, Hershey, PA.

Marquez Hall, S. (2016, May). Assessment Tool for Elder Safety on the Topics of Falls Risk and Elder Mistreatment. Presented at American Geriatrics Society Annual Scientific Meeting Education Product Showcase, Long Beach, CA.

Date posted: 
Wed, 10/05/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/05/2016
Product Viewing Instructions: 
Select your activities and add them to your cart. In the cart, click Proceed to Checkout. You will be prompted to create a new account or log in to your existing one. Once your account is created, you will be directed back to complete your registration.
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Geriatric Education and Training in Texas: Fall Risk Education & Assessment. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

Geriatric Interprofessional Teaching Clinic (GITC)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 
•Collaborative interprofessional practice and care are essential to the complex healthcare needs of a rapidly growing older adult population.
•Interprofessional collaboration (IPC) occurs when various health care practitioners, clients and/or caregivers work together to improve a client’s overall health.
•Teaching an IPC model continues to be a major gap in every health professionals’ education.
•To address this gap, the Geriatrics Interprofessional Teaching Clinic (GITC) at the University of Kansas Medical Center's Landon Center on Aging was created. It incorporates six professions: Students and faculty from  Physical Therapy, Medicine, Pharmacy, Social Welfare, Dietitics/Nutrition and Occupational Therapy.
•It is scheduled one half day a week with four patients scheduled on a "rolling" basis allowing for interprofessional teams of three to see patients in a staggered fashion. On average, each visit takes approximately 60-90 minutes.
•Logistically, students from 3 professions review the medical record together, discuss what they want to accomplish in the room, and how they will approach the patient encounter as a team. The students then see the patient and report back to the attending physician and other health professions faculty as a team. The assessment and plan for the patient is developed by the team.
•Team members are asked to define their roles by what the patient needs at that particular visit, starting with their own professional training and scope of practice, but then encouraged to allow themselves to participate in new ways. The interprofessional clinic faculty assist the learners by facilitating reflection on their clinical performance as individuals and as a team at the time of the clinic visit, incorporating their reflections into their next clinical encounter and through debriefing.
•To quantify interprofessional collaboration, evaluation tools are being piloted to assess for team dynamics, and surveys are sent out to each individual learner to assess for behavior and attitude changes. These are both done at the "beginning" and "end" of their GITC experience.
 
 
Educational objectives: 
•Create an interprofessional (IP) clinic involving multiple learners, emphasizing the national interprofessional competencies (values/ethics, roles/responsibilities, interprofessional communication and teams/teamwork).
•Train students in IP teams to evaluate their communication with the patient and with other team members following a patient encounter in GITC using a validated rubric. 
•Monitor changes in IP team behavior through individual learner evaluations.
Date posted: 
Mon, 10/10/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/10/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Interprofessional Teaching Clinic (GITC). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

Introduction to the Geriatric History and Physical Exam

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

With a growing number of older adult patients entering the health care system and fewer students and residents pursing geriatric medicine,1,2 it is critical to prepare all medical students, no matter their specialty choice, with the basic knowledge and skills needed to care for the older adult population. 

The Geriatric History and Physical Exam Skills Module was designed to orient pre-clinical medical students to the common screening tools, physical exam maneuvers and common findings relevant to older adult patients.  This highly interactive module also presents pertinent modifications that need to be made when interviewing and examining the population.  The resource is most useful for second year medical students who have been introduced to history and physical exam skills on normal adult patients.  Requiring about 15 minutes to complete, this module incorporates self-assessment questions, radiographic images and high yield concepts for an early medical student.

 

References

  1. Golden, A. G., Silverman, M. A., & Mintzer, M. J. (2012). Is geriatric medicine terminally ill?. Annals of internal medicine, 156(9), 654-656.
  2. Golden, A. G., Silverman, M. A., & Issenberg, S. B. (2015). Addressing the shortage of geriatricians: What medical educators can learn from the nurse practitioner training model. Academic Medicine, 90(9), 1236-1240.

 

Educational objectives: 

By the end of the module, a learner will be able to:

  1. Recognize pertinent modifications for the interview and clinical exam of older adults
  2. Practice functional assessment and physical exam maneuvers of older adults by responding to questions
  3. Identify common findings in the geriatric exam
  4. Utilize screening tools to identify common geriatric syndromes
Date posted: 
Thu, 02/04/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 02/04/2016
Contact Person/Corresponding Author:



Suggested Citation:
Introduction to the Geriatric History and Physical Exam. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/106

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