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.

Aging Q3 Curriculum on Falls and Mobility of Older Adult Patients

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

Using the Assessing Care of Vulnerable Elders (or ACOVE) paradigm and the principles of Academic Detailing, Aging Q3 is developing curricula on 16 different topics for teaching residents about providing quality care to elderly patients. Aging Q3 uses a sequence of multiple interventions where residents learn and experience the practice of Geriatrics in the clinical setting with limited interruption to the process of patient care. Each ACOVE is featured for 3 months. The curriculum includes a resident lecture during one of the residents' scheduled noon conferences, a handout used by the faculty to detail the resident on the issue during precepting or rounds, a poster which is displayed strategically in resident areas of the hospital and clinic, and observed demonstration and assessment of a defined skill. Residents are "cued" to address the featured issue with their elder patients by a "Blue Sheet" which contains a few brief questions on the ACOVE topic that the Patient Care Technician or Nurse have discussed with the patient during intake. Residents are assessed pre and post on knowledge, skill, and attitude by a Survey Monkey questionnaire.

The Falls and Mobility "ACOVE" is number 2 of 16 different curricula being developed in Aging Q3.

Educational objectives: 
  1. Recognize the risk factors, consequences, and interventions associated with falls in the older adult patient. 
  2. Demonstrate a "Timed Up and Go" test on an older adult patient.
Publications from, presentations from, and/or citations to this product: 

Caton C, Wiley MK, Zhao Y, Moran WP, Zapka J. Improving internal medicine residents' falls assessment and evaluation: an interdisciplinary, multistrategy program. J Am Geriatr Soc. Oct 2011;59(10):1941-1946. Also available online

Date posted: 
Thu, 08/23/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 08/23/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . Aging Q3 Curriculum on Falls and Mobility of Older Adult Patients. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/107

Texas Tech Medcast Reynolds Geriatric Step 2CK Test Prep Series 10-11: No. 61--Lights Out Larry

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

The Step2CK Test Prep Series was created by fourth-year students at the Texas Tech School of Medicine in Lubbock as a project of the fourth-year geriatrics rotation. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step 2CK Sample Exam. For more information on the series, go to http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Educational objectives: 

This episode is based on Question 61 on page 44 of the 2010 Step2CK Sample Exam.

Learning Objectives: the third-year medical student studying for the Step2CK exam should be able to

  • Define the clinical features of an absence seizure
  • Define the signs, symptoms, and physical exam findings of aortic stenosis
  • Recognize common clinical situations precipitating an episode of syncope in a patient with carotid sinus hypersensitivity
  • Recognize the features of a generalized tonic-clonic seizure
  • Recognize the clinical presentation of neurocardiogenic syncope
  • Diagnose a Transient Ischemic Attack in a patient in the ER.
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , and . Texas Tech Medcast Reynolds Geriatric Step 2CK Test Prep Series 10-11: No. 61--Lights Out Larry. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/107

Using a checklist to evaluate hospitalized patients who suffer a fall

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

This 45 minute Power Point presentation is designed to provide trainees and practicing hospitalists with an approach to the evaluation of hospitalized patients who fall. It was originally developed to provide advice to interns and residents at the University of New Mexico upon implementation of our hospital’s multidisciplinary falls prevention program.  It is case-based, includes a brief review of the evidenced-based literature, and then gives the authors’ opinions about how best to approach this situation. Also included is a list of pertinent literature and a multidisciplinary checklist, developed by the authors and used at the University of New Mexico Hospital.

Educational objectives: 

1. Identify at least 3 factors that are epidemiologically associated with falls in the elderly.

2. State the most common etiology of falling in the elderly.

3. Summarize the epidemiology of in-patient falls.

4. Describe the three steps in evaluating the in-patient who  falls

5. Demonstrate an appropriate bedside evaluation for injury of an in-patient who has fallen. 

6. Demonstrate how a multi-disciplinary team can use a checklist to evaluate and manage a hospitalized patient who has fallen.

Additional information/Special implementation requirements or guidelines: 

This presentation was specifically designed for the in-patient hospital setting. The authors do not advocate using this approach in other settings (such as emergency departments, skilled nursing facilities, or nursing homes). Many of the recommendations are based on the authors’ opinions as there is little-evidenced based literature in this area. The authors are formally studying the clinical usefulness of the checklist, and are especially interested in comments, critical appraisals, and similar experience of others. Contact the authors at jrpierce@salud.unm.edu.

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

Pierce JR Jr, Kearney D, Cumbler E. Development of a post-fall multidisciplinary checklist to evaluate the in-patient fall [abstract]. Society of Hospital Medicine, 05/13/2011, Dallas, TX

Date posted: 
Fri, 10/07/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/07/2016
Contact Person/Corresponding Author:



Suggested Citation:
, and . Using a checklist to evaluate hospitalized patients who suffer a fall. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/107

PATCH (Palliative Access Through Care at Home) Match: Virtual Training in Geriatric Palliative Home Visits

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

PATCH Match is a competency-based, virtual training experience in geriatric palliative home care, accessible online and suitable for a wide range of health care professionals such as medical and nursing students, residents, fellows, and others. Through simulated home visits, PATCH Match aims to teach learners to recognize that visiting frail older adults in their homes provides a more comprehensive understanding of patients, and that palliative care can be delivered effectively on home visits. Learners visit up to 4 homebound elderly patients, and face decisions about assessment and treatment relating to issues in: dementia with acute agitation, dementia with pain, falls at home, and transitions of care (from hospital to home). 

Educational objectives: 

After "visiting" the PATIENT WITH DEMENTIA AND PAIN, learners should be able to:

  1. recognize atypical ways in which pain may present in patients with advanced dementia,
  2. assess pain in patients with advanced dementia,
  3. identify options for pain treatment in patients with advanced dementia, and
  4. discuss the caregivers' role in caring for patients with advanced dementia and pain.

After "visiting" the PATIENT WITH DEMENTIA AND AGITATION, learners should be able to:

  1. recognize that agitation can be a symptom of emotional or physical distress in patients with advanced dementia,
  2. explain how the environment can have a positive or negative effect on agitated patients with dementia,
  3. describe behavioral and communication strategies for managing agitation in patients with dementia.

After "visiting" the PATIENT WITH RECENT FALLS, learners should be able to:

  1. report common causes of falls at home,
  2. name components of a falls risk assessment,
  3. recognize that most falls are the result of multi-factorial causes,
  4. explain how medications may contribute significantly to falls, and
  5. identify strategies for falls prevention that maximize patients' function and minimize injury.

After "visiting" the patient recently discharged from the hospital (TRANSITION OF CARE), learners should be able to:

  1. recognize problems that occur in the transition from hospital discharge to home relating to medication use and communication about hospital care and follow up,
  2. explain the teach-back method of communicating with patients and families, and
  3. discuss how a multi-disciplinary team and social support system may be engaged during transitions from hospital to home
Date posted: 
Fri, 11/12/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 11/12/2010
Contact Person/Corresponding Author:



Suggested Citation:
, and . PATCH (Palliative Access Through Care at Home) Match: Virtual Training in Geriatric Palliative Home Visits. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/107

Focused Neuro Exam for a Patient with Falls

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

This video will instruct medical students and post graduate trainees on how to perform a thorough neurological examination when assessing an older adult with falls. It stresses examination technique as well as tools used in the assessment as a demonstration using a simulated patient encounter in a clinical setting.

Educational objectives: 

Objective of the neurologic exam in assessing falls: 1. Develop an understanding of the terminology and tools used to assess neurologic function in older adults 2. Recognize symptoms which suggest neurologic dysfunction in relation to falls in older adults

Date posted: 
Tue, 02/23/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/26/2012
Contact Person/Corresponding Author:



Suggested Citation:
Focused Neuro Exam for a Patient with Falls. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/107

Falls in Older Adults

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

This product is part of the GeriaSims series of interactive patient care simulations. In this simulation, learners ask history questions, perform virtual physical exams, order tests, consult with specialists and other health care professionals. They will make decisions about diagnosis, treatment, and other issues in the care of an elderly patient who has fallen and/or is vulnerable to falls, and receive feedback about all actions and decisions. Learners may also ask questions of a simulated mentor to access didactic information about functional assessment. Depending on the learner's level of experience and interest, the simulation takes one to two hours to complete.

GeriaSims interactive patient care simulations are available online, both to accredited medical education institutions for use with students, residents, and fellows. For more information about the GeriaSims series, go to http://www.healthcare.uiowa.edu/igec/resources-edu....

 

Educational objectives: 

GeriaSims are interactive experiences during which the learner diagnoses and treats simulated patients. The simulations are designed to provide interactive learning experiences about geriatric syndromes and other issues that are often encountered in the primary care of elderly patients. Learners will be able to improve their overall knowledge about managing common geriatric syndromes; understand the unique health care needs of older patients, differences in the management of common clinical conditions, and how physiologic changes associated with aging impact management. They will develop a working knowledge of important legal and ethical issues associated with end-of-life care; and understand and apply principles of the multi-disciplinary geriatric assessment.

The learning objectives of this particular simulation are:

  1. Take a patient history and perform a physical exam specific to falls.
  2. Know when and how to conduct simple gait and balance assessments.
  3. Identify intrinsic and extrinsic factors contributing to a fall, or that may increase future risk of falling.
  4. Formulate a treatment plan that minimizes the risk of future falls and morbidity from falls, while maximizing the patient's independence and quality of life.
  5. Recognize when to call on other practitioners in evaluating the patient and formulating a treatment or management plan.
Additional information/Special implementation requirements or guidelines: 

These simulations were developed using a software template created by the University of Iowa. They are used in primary care residency programs and rotations for medical students in the clinical years at the University of Iowa, and also offered online for CME credit.

To use GeriaSims, a 256K or faster DSL, cable modem, LAN/Intranet, or other broadband Internet connection; Internet Explorer 6.0 or higher, Netscape 8.0 or higher, Firefox 1.0 or higher, Mozilla 1.7.5 or higher, or Safari 1.3 or higher web browser, with Java script enabled; version 8 or later of the Flash Player; and Adobe Reader 5 or later are required. A sound card and speakers are recommended. GeriaSims are best viewed at a screen resolution of 1024 x 768, but can be viewed at 800 x 600.

Date posted: 
Fri, 08/21/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 08/21/2009
Contact Person/Corresponding Author:



Suggested Citation:
Falls in Older Adults. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/107

Web-based Interactive Self-Assessment Learning Module 1: Falls and Dysmobility in Older Adults

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

This product includes several quick reference sheets along with a web-based interactive learning module on Falls and Dysmobility in Older Adults, which provides students in a geriatric clerkship rotation with a self-assessment of knowledge required in diagnosing and managing older patients with an increased risk for falls. This learning module covers broad issues on management of the aging syndrome to increase students’ knowledge, skills, and confidence in managing medically complex older patients. 

Educational objectives: 

Students will gain knowledge required in diagnosing and managing older patients with an increased risk for falls.

Additional information/Special implementation requirements or guidelines: 

An internet connection is required to access the self assessment web module.

For more information about this program at the University of Florida, go to http://aging.ufl.edu/education/the-4th-year-required-geriatrrehabilitation-clerkship/learning-modules/

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

Bautista MK, Meuleman JR, Shorr RI, Beyth RJ. Description and Students' Perceptions of a Required Geriatric Clerkship in Postacute Rehabilitative Care. Journal of American Geriatrics Society 57:1685-1691, 2009.

Date posted: 
Thu, 11/19/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/06/2012
Contact Person/Corresponding Author:



Suggested Citation:
and . Web-based Interactive Self-Assessment Learning Module 1: Falls and Dysmobility in Older Adults. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/107

Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents

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

“Competency-based education prepares trainees to perform tasks occurring within the context of practice. Teaching to competency differs from traditional instruction. It begins by stating the performance we expect of our graduates in the workplace and then designing the medical school curriculum to prepare our learners to achieve that performance through deliberate practice in applying the underlying knowledge, skills, and attitudes.” As the elderly population in America "booms," medical education must address the issue at hand and modify their curriculum and teaching practices to give credence to geriatric principles within medical care. It is imperative for many reasons (socially, financially, etc.) that we ensure competency in the care of older adults for every physician.

To help achieve this lofty goal, the Minimum Geriatric Competencies have been developed for Medical Students and are being developed for multiple residency disciplines. The files within this product showcase the Medical Student Minimum Geriatric Competencies (published in Academic Medicine, May 2009), Internal Medicine – Family Medicine Resident Minimum Geriatric Competencies (published in Journal of Graduate Medical Education, Sept 2010), and Emergency Medicine Resident Minimum Geriatric Competencies (published in Academic Emergency Medicine, 2010).

Additional information/Special implementation requirements or guidelines: 

The "Side-by-Side" document shows the progression from Medical Student Competencies into resident education.

The documents included with this product are:

  • Emergency Medicine Resident Competencies
  • Medical Student Competencies
  • IM-FM Resident Competencies
  • Side-by-Side Competencies Comparison
Publications from, presentations from, and/or citations to this product: 

Leipzig R M, Granville L, Simpson D, Brownell Anderson M, Sauvigne K, and Soriano R P. (2009). Keeping granny safe on July 1: Consensus on minimum geriatric competencies for graduating medical students. Academic Medicine, 84, 604–610. Also available at http://journals.lww.com/academicmedicine/Fulltext/2009/05000/Keeping_Granny_Safe_on_July_1__A_Consensus_on.17.aspx

Hogan T M, Losman E D, Carpenter C R, Sauvigne K, Irmiter C, Emanuel L, and Leipzig R M. (2010). Development of geriatric competencies for emergency medicine residents using an expert consensus process. Academic Emergency Medicine, 17(3), 316-324. Also available at http://dx.doi.org/10.1111/j.1553-2712.2010.00684.x

Williams B, et al. (2010). Medicine in the 21st century: Recommended essential geriatrics competencies for Internal Medicine and Family Medicine residents. Journal of Graduate Medical Education, 2(3), 373-383. Also available at http://www.jgme.org/doi/abs/10.4300/JGME-D-10-00065.1

Date posted: 
Thu, 01/01/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 06/08/2011
Contact Person/Corresponding Author:



Suggested Citation:
Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/107

Texas Tech Medcast Reynolds Geriatrics Step2CK Prep Series: No. 41 (Kaplan USMLE Step 2CK Qbook, 2005)--Help--I've Fallen and I Can't Get Up!--But Why?

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

The Step2CK Test Prep Series was created by fourth-year students at the Texas Tech School of Medicine in Lubbock as a project of the fourth-year geriatrics rotation. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2008 Step2CK Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri.... For more information on the series, go to http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri....

Educational objectives: 

This episode is based on Question 41 on page 82 of the 2005 Kaplan Step2CK QBook.

Learning Objectives: the third-year medical student studying for the Step2CK exam should be able to:

  • Identify the importance of adverse drug effects on the geriatric population including reasons for variable drug effects, common drugs to avoid and the significance of the Beers list of inappropriate pharmacologic interventions
  • Emphasize the types of musculoskeletal deficits in Parkinson's Disease as well as common presentations
  • Discuss the cause, symptoms, and management of postural hypotension
  • Identify symptoms associated with ischemia in the internal carotid distribution and differentiate them from ischemia in other areas of cerebral circulation.
  • Identify the signs and symptoms of vertebrobasilar insuffiency.
Date posted: 
Fri, 08/07/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
Texas Tech Medcast Reynolds Geriatrics Step2CK Prep Series: No. 41 (Kaplan USMLE Step 2CK Qbook, 2005)--Help--I've Fallen and I Can't Get Up!--But Why?. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/107

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