The Portal of Geriatrics Online Education

13 FBG: Construct diagnosis and evaluation plan for fallen patient

13. In a patient who has fallen, conduct a gait assessment and construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment.

Housecalls Pocket Card

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

This pocket card is designed to prepare learners to conduct a home visit.  The pocket card can be reviewed prior to a visit to help prepare the learner with appropriate equipment and materials (forms, medical supplies) and can help guide the learner during the visit to ensure that a thorough assessment is completed.

Educational objectives: 
  1. Prepare learner for conducting a home visit by identifying equipment needed, and outlining the visit
  2. Learn to thoroughly assess patients home for safety, including environmental risks, medication risks, and elder abuse
  3. Identify unmet needs in a home-bound patients by performing a thorough medical, functional and social assessment at home
  4. Perform a thorough medication review in the patients home
  5. Perform an assessment of function, based upon self-reported history, caregiver history and observation.
  6. Determine which services may need needed for a homebound adult
Date posted: 
Wed, 02/18/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 02/18/2015
Contact Person/Corresponding Author:



Suggested Citation:
Housecalls Pocket Card. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/107

Gait Disorders in the Elderly

:  
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: 

This educational modules teaches learners how to recognize normal patterns of gait in the elderly and discuss various geriatric gait disorders.  There is a quiz at the end of the module.

Educational objectives: 

After reviewing the module, learners should be able to:

1) observe and assess gait disorders in the elderly.

2) classify and describe gait disorders in the elderly.

3) know when to refer for more specialized care.

Additional information/Special implementation requirements or guidelines: 

Authors:  Richard B. Dewey, Jr., MD; Shilpa Chitnis, MD; Cherian Abraham Karunapuzha, MD

Geriatrician: Amit Shah, MD

Medical Illustrator: Lindsay Oksenberg, MA

Date posted: 
Wed, 12/10/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/10/2014
Product Viewing Instructions: 
Quicktime is needed
Contact Person/Corresponding Author:



Suggested Citation:
Gait Disorders in the Elderly. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/107

Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
3
Abstract: 

Interprofessional education (IPE) occurs when students/trainees of two or more healthcare professions engage in learning with, from, and about each other, and is viewed as a primary mechanism through which to improve interprofessional teamwork and the quality and safety of patient care. This Interprofessional Standardized Patient Exercise (ISPE) was created to provide health professions students with a structured learning experience working within an interprofessional health care team. The case of “Elsie Smith” involves multiple complex chronic medical conditions in an older adult with many needs and limited resources. It highlights the need to address medical, functional status, and social domains, among others, and accordingly is designed to be relevant to many health professions. It can easily be adapted according to the types of health professions students available. At our University, participants were from seven schools or programs: dentistry, medicine, nursing, nutrition, pharmacy, physical therapy, and social work. All students were in their 3rd or 4th year, except for the nurse practitioner and social work students, who were in their 2nd year of training, and dieticians completing a one year internship. Students work in interprofessional teams to interview the standardized patient and create an integrated, comprehensive patient care plan. Faculty facilitators from participating schools/programs observe the students and lead debriefing sessions.

Educational objectives: 
  1. Students will demonstrate the ability to effectively communicate and collaborate with students from other health professions.
  2. Students will demonstrate the ability to efficiently interview and assess a patient with multiple chronic illnesses, showing sensitivity to a patient’s personal needs and resources.
  3. Students will develop a comprehensive care plan in collaboration with other health professions students to meet the patient’s healthcare needs.
  4. Students will describe the role of other healthcare professionals in caring for a patient with multiple chronic illnesses.
Additional information/Special implementation requirements or guidelines: 

This material was initally posted on MedEdPORTAL:

Rivera J, Yukawa M, Hyde S, Fitzsimmons A, Christman J, Gahbauer A, Scheid A, Wamsley M. Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”. MedEdPORTAL; 2013. 

www.mededportal.org/publication/9507

Publications from, presentations from, and/or citations to this product: 
Date posted: 
Wed, 09/24/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/22/2018
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/107

Geriatric EMR Templates

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

This project involved “geriatricizing” the EMR through the creation of geriatric templates so that it could be used to enhance geriatric education in required geriatric experiences.  The program includes geriatric templates that have been collapsed into a word document to allow interested programs the ability to adapt templates to their institutional EMR systems as well as a facilitator's guide that describes the background, rationale, description and outcome data related to the implementation of the program in a medical school curriculum.

Educational objectives: 

After utilizing the geriatric EMR templates, the learner will be able to:

  • Complete a comprehensive geriatric assessment,
  • Document critical geriatric patient information in an electronic medical record, and
  • Describe common geriatric symptoms, findings and diagnoses.
Additional information/Special implementation requirements or guidelines: 

Templates must be adapted to templates in an organizational EMR system.  There may be limitations in the functionality of certain EMR systems that should be taken into account before implementing the program.  The authors described the templates as they used in them in SOAPware.

Date posted: 
Wed, 11/13/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 03/16/2018
Contact Person/Corresponding Author:



Suggested Citation:
, , and . Geriatric EMR Templates. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/107

Precise Evaluation of the Geriatric Patient in the Emergency Department

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

Background: The number of Emergency Department (ED) visits by patients over age 65 is increasing rapidly. Common chief complaints, such as abdominal pain, often are associated with atypical presentations and significant morbidity and mortality. Hence, it is important for Emergency Medicine (EM) physicians to have both a high suspicion for disease and an in-depth knowledge base when treating these patients. However, the unique presentations of disease in older patients are rarely focused on during EM residency training. The authors created an innovative, interactive small group activity with five cases of older patients presenting to the ED, focusing on fundamental disease processes and presentations, for training EM residents.

Methods: EM residents are divided into teams and challenged to provide the most efficient, cost-effective care in five cases. Using play money, the residents are given limited funds to perform specific exam components and order laboratory studies and imaging. After teams complete the cases, a debriefing is performed in a large group to discuss learning points, highlighting diagnoses and treatments specific to geriatric patients. This activity was developed for EM residents but has since been adapted for use with medical students and residents and faculty from other specialties, including Internal Medicine and Surgery.

Results: EM residents were very receptive to this exercise. On evaluations, they appreciated the interactive learning and case-based teaching. On a scale from 1-5, with 5 being the highest score, residents rated the overall quality of the session and teaching effectiveness as 4.6 and 4.3, respectively. Comments included: “awesome case format” and “very clinically applicable”.

Conclusions: A case-based, interactive small group exercise is an innovative way to educate EM residents about emergencies and atypical presentations in geriatric patients. These cases also can be adapted for residents in other specialties as well as for faculty and medical students.

Educational objectives: 

On completion, the learner will:

  • Understand Geriatric Emergency Medicine as its own subspecialty, with unique and evolving knowledge base and skills

  • Be wary of "under-triaging" geriatric patients, especially trauma patients

  • Identify acute abdominal pain in geriatric patients as often life threatening

  • Utilize the Mini Cog and ICU CAM

  • Identify delirium and understand that it requires further evaluation for an underlying cause

  • Treat pain appropriately in older patients

  • Treat agitation appropriately in older patients

  • Prepare for care transitions
Additional information/Special implementation requirements or guidelines: 

This is an interactive, case-based didactic on the evaluation of older patients in the Emergency Department (ED). This product consists of five cases of common chief complaints in the ED, as well as a lecture to describe the importance of Geriatric Emergency Medicine (EM) and highlight the keypoints of each case. The didactic is intended to begin with the Power Point lecture as a large group. Then, learners will break out in smaller teams to complete the "Precise Evaluation of Older Patients in the ED Game." Each team is provided with the packet of cases and play money, which can better demonstrate cost. The teams will work through the differential diagnoses on each case and selectively order tests to identify the correct diagnosis. Teams must keep track of the tests ordered on each case as well as total money spent. Either facilitators or one member of each team can provide results to the team from the appropriate answer key for each case. Teams then return to the large group to debrief and discuss each case. The lecture provides key learning points on each case specifically related to Geriatric EM, including atypical presentations and management. The winning team can be rewarded for spending the least while arriving at the correct diagnoses. The workshop in its entirety takes about 2 hours; however, less cases can be used for a shorter didactic. In addition, more cases can easily be added to this exercise to discuss other dieases processes. This curriculum has been used with EM residents as well as residents and faculty from other specialties and medical students.

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

Waller N, Biese K, Barrio K, Howarth C, Roberts E, Busby-Whitehead J. “Geriatric Abdominal Pain Game.”  Society of Academic Emergency Medicine 2013. Atlanta, Geargia. May 16, 2013. (Poster, Solicited).

Waller N, Biese K, Barrio K, Howarth C, Roberts E, Busby-Whitehead J. “Material and Methods Swap: Geriatric Abdominal Pain Game.” American Geriatrics Society 2013. Grapevine, Texas. May 5, 2013. (Oral Presentation, Invited).

Waller N, Biese K, Barrio K, Howarth C, Roberts E, Busby-Whitehead J. “Geriatric Abdominal Pain Game.”  American Geriatrics Society 2013. Grapevine, Texas. Denver, Colorado. May 3, 2013. (Poster, Solicited).

Waller N, Biese K, Barrio K, Howarth C, Roberts E, Busby-Whitehead J. “Educational Soundbites: Geriatric Abdominal Pain Game.” Council on Emergency Medicine Residency Directors Academic Assembly 2013. Denver, Colorado. March 7, 2013. (Oral Presentation, Invited). (1 hour, 200 faculty members)

Waller N, Biese K, Barrio K, Howarth C, Roberts E, Busby-Whitehead J. “Geriatric Abdominal Pain Game.” Council on Emergency Medicine Residency Directors Academic Assembly 2013. Denver, Colorado. March 7, 2013. (Poster, Solicited).

Date posted: 
Thu, 09/05/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/05/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Precise Evaluation of the Geriatric Patient in the Emergency Department. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/107

Prescription for Safety and Well Being: Home Modifications

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

  This one hour video lecture with accompanying PowerPoint slides decribes possible home modifications for older adults and ways older adults can stay safe in thier homes. The target audience is Interdisciplinary Health Care Professionals.

Educational objectives: 

 List home modifications that promote safety for older adults in the home.

Additional information/Special implementation requirements or guidelines: 

Please note: The speaker was caught in traffic so the first 9 minutes of presentation are Q&A with Dr. James Powers about home and safety modifications from a MD perspective. This material is from the Geriatrics and Gerontology Interest Groups (GGIG) of Vanderbilt University

This video may take a few moments to load based on your connection. Please wait if it does not appear right away.

Date posted: 
Wed, 05/22/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 05/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
Prescription for Safety and Well Being: Home Modifications. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/107

"The Case of Sherman Davis: An Interprofessional Analysis of Geriatric Medical Problems"

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

This case demonstrates the evaluation and care of an elderly gentleman who has fallen.  The complexity of caring for the geriatric patient becomes evident early in the case.  The following points are emphasized:

(1) medical problems common in elderly patients include falls, fluid and nutrition problems;

(2) the elderly often present with common problems in an atypical way;

(3) the morphologic, microbiologic, and epidemiologic aspects of tuberculosis;

(4) interprofessional teams are needed to provide optimal care.

Educational objectives: 

The students will be able to formulate a broad differential diagnosis for an elderly patient after receiving physical and history information. It is important to stress the difficulties in formulating a differential diagnosis when patient history is lacking, but also to discuss strategies to overcome these barriers (e.g. multi-professional evaluation, collateral source history). The students will then be given additional laboratory and x-ray results and more history from the patient's nephew. This will allow the students to narrow  differential diagnoses down. There is much happening with this patient. Students will understand that patients, especially the elderly, do not always present with one problem. By the end of the session, the students will be able to review the care of the patient and have a good understanding of most learning objectives in the case, including those for tuberculosis and community acquired pneumonia.

Additional information/Special implementation requirements or guidelines: 

This case will be used with second-year medical students as part of  the Introduction to Disease Processes Core. This Interprofessional Problem-Based Learning Case will be used as a small group activity (10-12 students) with 1-2 faculty leaders.

Date posted: 
Sun, 01/01/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 07/31/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , and . "The Case of Sherman Davis: An Interprofessional Analysis of Geriatric Medical Problems". POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/107

Cognitive Screening and Functional Assessment OSCE

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
3
Abstract: 

This product contains materials for the completion of a Cognitive Screening and Functional Assessment OSCE. Instructional guides for the standardized patients, the student, and the preceptors are included. There is a template for the evaluation of the student's performance, completion of the Mini-Cog, and documentation of the plan for the patient. Finally, the product includes a description of the proposed timing, a student self assessment, and an evaluation form for the OSCE.

Educational objectives: 

On completion, the learner will be able to:

  1. Demonstrate the use of the Mini-Cog for the evaluation of a patient with suspected cognitive impairment
  2. Demonstrate the use of the Get-Up and Go Test on a patient who has fallen
  3. Develop a preliminary management plan for a patient with gait abnormalities and cognitive impairment

  4.  
Date posted: 
Fri, 01/11/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 04/13/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . Cognitive Screening and Functional Assessment OSCE. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/107

Falls in Older Patients - A Fact Sheet and Pre/Post Test

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

This fact sheet, along with the accompanying pre- and post-test, teaches physicians-in-training about the predisposing factors, consequences, assesments and interventions for falls in geriatric patients.

Educational objectives: 

Upon completion, learners should be able to:

  • Describe modifiable and nonmodifiable risk factors that predispose patients to falling
  • Discuss the consequences of falling
  • Evaluate a  patient’s risk for falling in a multifactorial assessment
  • Choose individualized interventions that will help prevent the patient from falling in the future
Date posted: 
Thu, 05/23/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 05/23/2013
Contact Person/Corresponding Author:



Suggested Citation:
Falls in Older Patients - A Fact Sheet and Pre/Post Test. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/107

Interprofessional Team Care Symposium for Medical Students

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

The successful medical care of adults with multiple medical, functional and social problems requires the expertise of multiple health disciplines working together effectively. Physicians must be aware of the skills of the interprofessional health disciplines and learn how to work effectively in teams. This product describes a two hour, interactive intensive introduction to the training and roles of the interprofessional health care team members taught by faculty from nursing, physical therapy, occupation therapy, speech therapy, pharmacy, audiology, nutrition, social work and medicine. The format is a fast moving, interactive health team fair based on a case of an older adult recovering from a stroke. 

After a brief introduction and review of the stroke case, medical students in groups of 5-8 move from station to station in 10-15 minute intervals. At each station, faculty from a health care discipline describe their educational background and discuss how they will assist the students to manage the stroke case. At the last station students receive a case summary and a packet of descriptions summarizing each of the health care disciplines. 

 

Educational objectives: 

Participating medical students will be able to:

  1. Describe the training required to enter eight different health professions.
  2. List one or more clinical problems that might benefit from collaboration with eight different health professions.
  3. Apply the knowledge of the clinical skills of other health disciplines to provide care to an older adult recovering from a stroke.
Additional information/Special implementation requirements or guidelines: 

This curriculum requires:

Recruitment of teaching faculty from allied health colleges or hospital departments.

A large, open space, such as might be used for a research poster session (e.g., large entry hall way) or multiple small classrooms that are close to each other as might be used for medical student small gorup learning communities.

Two hours of curriculum time for 50-80 students; for larger class sizes the session will need to be repeated two or three times to accomodate everyone.

Date posted: 
Tue, 07/15/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/15/2014
Contact Person/Corresponding Author:



Suggested Citation:
, and . Interprofessional Team Care Symposium for Medical Students. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/107

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