The Portal of Geriatrics Online Education

Geriatric Palliative Care

Geriatric Emergency Medicine Online Curriculum (GEM-OC) 1 - Advance Directives

:  
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 is Module One of an online five-module curriculum.  The modules, which are based on national geriatric emergency medicine competencies, cover a broad range of geriatric topics through an interactive teaching format.  They require learners to review and analyze patient information, interpersonal interactions, laboratory and imaging results, diagnoses and treatment plans. This module teaches advance directives and palliative care.

Educational objectives: 

At the end of Module One, the learner should be able to:

1) Define and differentiate among types of code status, health care proxies, and advance directives in the state where one is training.

2) Accurately identify clinical situations where life expectancy, functional status, patient preference and goals of care should override standard recommendations for screening and treatment in older adults.

3) Present palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease.

4) Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits dementia, delirium, or depression.

5) In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root cause (etiology).

Additional information/Special implementation requirements or guidelines: 

For best viewing results, please:

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  • Avoid using browser navigation. Use only the navigation provided within the course.

 

Date posted: 
Tue, 10/19/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 08/08/2011
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Geriatric Emergency Medicine Online Curriculum (GEM-OC) 1 - Advance Directives. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

Advance Directives

:  
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 module is intended to assist in teaching undergraduate medical students about advance health care planning; including, the various documents available to the provider for discussion and documentation of the wishes of patients and their surrogate decision makers. This module also discusses the issues of determination of decisional capacity and competency, with an approach provided to assess decision-making capacity. Additionally, students are provided information on the advance directive discussion and communicating with patients, families and surrogate decision makers.

Educational objectives: 

Attitudes - Medical students should be able to:

  1. Realize the importance of establishing the wishes of the patient prior to their loss of decisional-capacity when surrogacy would be required.
  2. Realize the importance of the role of the health care provider in providing the patient and their family a realistic and clear understanding of the patient's clinical situation and likely prognosis.
  3. Acquire an ability to effectively engage patients and families in discussion of these issues.

Knowledge - Medical students should be able to:

  1. Discuss a Living Will, including the definition, acquisition, utility, and limitations.
  2. Discuss a Health Care Treatment Directive, including the definition, acquisition, utility, and limitations.
  3. Discuss a DNR, including the definition, acquisition, utility, and limitations.
  4. Discuss a Durable Power of Attorney for Health Care, including the definition, acquisition, utility, and limitations.
  5. Recognize the cognitive and emotional qualities which contribute to the assessment of competency and decision-making capacity.
  6. Recognize the scope and importance of the legal context of advance directives.
  7. Recognize the importance of selected issues relating to advance directives.
  8. Describe how to appropriately begin the advance directive discussion.
  9. Describe the importance of communicating with families and surrogates concerning advance directives.
  10. Describe the importance of clarifying unclear statements.
  11. Describe the best approach to documenting the discussion of advance directives.

Skills - Medical students should be able to:

  1. Define the following entities and discuss how one acquires such a document: Living Will, Health Care Treatment Directive, DNR, Durable Power of Attorney for Health Care.
  2. Participate in a family "discussion" about these entities and recommend appropriate interventions for the patients presented in the case that follows and the Standardized Patient Encounter.
  3. Create a framework for how one would initiate and/or discuss such issues with real patients and families.
Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Product Viewing Instructions: 
N/A
Contact Person/Corresponding Author:



Suggested Citation:
and . Advance Directives. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

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

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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/1101

Advance Care Planning with Surrogate of Older Adult with Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Abstract: 

Medical students are given the opportunity in small groups to practice communication skills with a standardized patient.  Students assume the role of attending physician, who is in charge of this patient’s care while attending on the Acute Care for the Elderly (ACE) Unit, and speak to the patient’s adult child. The objective is to have the student discuss the patient’s clinical condition and what the goals of care should be during this hospitalization, i.e., whether the patient should be transferred to the ICU if she worsens and, if so, whether she should be intubated and resuscitated.

Educational objectives: 
  1. To discuss clinical condition of older adult with surrogate.
  2. To discuss goals of care for a hospitalized older adult with surrogate; specific to CPR, ventilation, and ICU level of care.
Date posted: 
Mon, 10/04/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/04/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Advance Care Planning with Surrogate of Older Adult with Dementia. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

"Can you help me out doc?" - Treatment of Pain in Persons with a History of Addictions

:  
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 self-directed learning exercise explores the approach to pain management in terminally ill patients with a history of substance abuse.  Through a video case presentation and related readings, the learners will identify challenges and optimal strategies for caring for this special population.  Four to five multiple choice test questions are included in this module.  A brief review and follow up with an instructor is recommended to go over the answers. A workbook is provided. Some external materials are required; see the instructions below.

Educational objectives: 

After completion of this module the student should be able to:

  1. Define addiction, physical dependence, pseudoaddiction, and tolerance
  2. Describe basic principles for prescribing controlled substances to patients with advanced illness and issues of addiction
  3. Recommend appropriate guidelines for clinical management of terminally ill patients with addiction
Additional information/Special implementation requirements or guidelines: 

In order to complete this module, you will also need to access the following:

  • Video "Pain Management for a Patient with a History of Substance Abuse" from The Center for Palliative Care Education
  • Article Kirsh KL and Passik SD. Palliative care of the terminally ill drug addict. Cancer Investigation 2006;24:425-431.
  • The answer key for this product will be provided to faculty members only. To request the answer key, send an email to Editor@POGOe.org titled "Request for Answer Key to Product #20723". Include your full name, your institution, your intended use of the product and any additional information relevant to the request. Also include your supervisor's full name, email address and phone number so that we may confirm your status as a faculty member.

This product is part of a series of 3 independent learning modules on pain for medical students and other learners.  Companion products are "Addressing myths and managing side effects of opioid medications" (#20724) and "Assessment and treatment of neuropathic pain" (#20725).   The workbook for this series can also be accessed at http://champ.bsd.uchicago.edu/painControl/index.html

Date posted: 
Wed, 12/08/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/08/2010
Contact Person/Corresponding Author:



Suggested Citation:
"Can you help me out doc?" - Treatment of Pain in Persons with a History of Addictions. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 140--To Feed or Not To Feed

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

The Step1 Test Prep Serices was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. 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 the series are based on questions that have geriatrics content and patient vignettes from the 2010 Step1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri...

Educational objectives: 

The second-year medical student studying for the Step1 exam should be able to:

  • Discuss the appropriateness of paternalism in medicine
  • Describe the ethical implications of a physician practicing paternalism in their practice
  • Understand the importance of advanced directives in the case of end-of-life care and the ethical dilemmas faced by family when an advanced directive is non-existent.
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 Geriatrics Step 1 Prep Series: No. 140--To Feed or Not To Feed. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

TEXAS Training Excellence in Aging Studies: Geriatric Gems and Palliative Pearls

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

"Geriatric Gems and Palliative Pearls" are a series of brief web modules, or "soundbytes", of geriatric medical topics developed by Texas Training Excellence in Aging Studies Program (TEXAS), funded by the D.W. Reynolds Foundation, and located at the University of Texas Medical School at Houston. UTH faculty developed the soundbytes using the AAMC and ACGME competencies germane to medical residents from a variety of speciality areas.   The "Gems and Pearls" are developed on andragogical principles employing brevity, repetition and an element of entertainment or compelling information to gain the learner's attention.  Each soundbyte takes about 3-5 minutes to review and is linked to videos, diagrams, text materials, and additional information on specific topics. Examples include Depression, Dementia, End-of-Life Issues and many others.

The rationale for using this form of educational methodology is based on research from the 70's and 80's showing that the spacing of education, repeated over time, results in more efficient learning and material retention than the massed presentation of educational materials.  This form of interactive spaced education (ISE) has been used by medical educators to teach physical diagnosis, effective feedback behaviors, and urology board review material.

Some of the topics covered include acute coronary syndrome, dementia, dying process, elder abuse, hazards of hospitalization, hospice, medical decision making, opioid toxicity, pain, self-neglect, urinary incontinence and executive function and capacity. 

Educational objectives: 

Learners will:

  1. Increase their knowledge, skills and attitudes in geriatric medicine
  2. Describe and differentiate variations in fundamental biomedical aspects of aging, geriatric assesment, and care coordination from younger adult populations; and
  3. Apply the knowledge and skills and demonstrate attitudes learned in caring fro geriatric patients in inpatient and outpatient clinical settings.
Date posted: 
Tue, 10/26/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/26/2010
Contact Person/Corresponding Author:



Suggested Citation:
, , , , and . TEXAS Training Excellence in Aging Studies: Geriatric Gems and Palliative Pearls. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1101

Geriatric Days Lecture/Small Group Series

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

A series of lectures and case discussions with small group interaction. Designed for M-2 level. Contains lectures, handouts, and case discussion materials on: Dementia, Delirium, Urinary Incontinence, Functional Ability and Disabilities, Falls, Aging Physiology, and End of Life Care. Will send materials upon request. Please email jwhittin@unmc.edu.

Educational objectives: 

To introduce and integrate basic geriatric knowledge in preparation for clinical years. FALLS Learners should be able to: 1) Describe the significance of falls. 2) List the age related changes that predispose to falls. 3) List the medications that predispose to falls. 4) List the etiologies of falling. 5) Describe the evaluation of a fallen elder. 6) List the techniques and treatments to prevent falls. DEMENTIA The student will be able to: 1) Understand essential elements of history in the diagnosis and differential diagnosis of dementia. 2) Describe aspects of the neurological exam essential to diagnosis of the causes a dementing illness. 3) Recognize motor systems such as tremor, gait problems, rigidity, and involuntary movements. DELIRIUM The student will be able to: 1) Define delirium. 2) Describe the clinical presentation of delirium. 3) List the major causes and contributing factors to delirium. 4) Initiate prevention of delirium. 5) Initiate management of delirium. URINARY INCONTINENCE IN ELDERLY PEOPLE The student will be able to: 1) Identify risk factors for urinary incontinence. 2) Describe the four most common types of chronic urinary incontinence. 3) Identify reversible contributors to urinary incontinence. 4) Describe the treatment options for each type of incontinence. 5) Develop a treatment plan for patients with urinary incontinence. PHYSIOLOGY OF AGING The student will be able to: 1) Translate understanding of physiologic alterations into clinical interventions to reduce morbidity and mortality. 2) Identify the clinical scenarios where altered physiology is likely to make a difference in the clinical course of patients. ABILITIES & DISABILITIES The student will be able to: 1) Describe the common causes and patterns of functional disabilities. 2) Perform an initial evaluation and initiate treatment planning. 3) Describe the role of the physician in the recognition and management of disabilities. 4) Describe the strategies for minimizing the occurrence and for recovering function.

Additional information/Special implementation requirements or guidelines: 

Will send materials upon request. Please email jwhittin@unmc.edu.

Date posted: 
Thu, 08/06/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 04/16/2010
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Days Lecture/Small Group Series. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/1101

PGY - 1 Geriatrics Workshop

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

This is a workshop directed at first year medical residents to introduce them to the basic principles of Geriatric medicine and an understanding how these principles may apply in the context of care for older patients. The workshop is targeted towards a group of 7-15 residents at a time. It can be given as one four-hour block, or divided into multiple shorter sessions. The workshop uses the Emory Basics in Geriatric 10 (BIG 10) as the structure for the talk. Please contact the author to obtain the DVD portion of this lecture.

Educational objectives: 

At the end of the session, learners should be able to: 1) Describe traditional medical thinking 2) Identify important principles of a geriatric medicine approach (BIG 10) 3) Determine decision making capacity in a basic fashion 4) Instruct patients on completion of advance directives in a basic fashion

Date posted: 
Fri, 12/01/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 11/01/2012
Contact Person/Corresponding Author:



Suggested Citation:
PGY - 1 Geriatrics Workshop. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1101

Palliative Care - Interactive Patient Care Simulation

:  
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, and make decisions about diagnosis, treatment, and other issues in the care of an elderly patient with terminal cancer, and receive feedback about all actions and decisions. Learners may also ask questions of a simulated mentor to access didactic information about palliative care. 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....

GeriaSims are also available to practicing physicians, physician assistants, nurses and nurse practitioners for CME or CEU credit. To receive continuing education credit, you must register for the Geriatric Lecture Series. For more information, go to http://www.healthcare.uiowa.edu/igec/e-learning/ge....

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. Perform a proper assessment of a patient in pain.
  2. Deliver "bad news" effectively and compassionately.
  3. Appropriately prescribe medications for control of pain and non-pain symptoms.
  4. Explain the basics of hospice care.
  5. Counsel a patient on advance directives.
  6. Manage a complex patient over the telephone.
  7. Address the common challenges encountered in the care of the imminently dying patient.
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.

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

Lim, L. S., Kandavelou, K. and Khan, N. (2012, June). Palliative Care Teaching in Medical Residency: A Review of Two POGOe Teaching Products. Journal of the American Geriatrics Society, 60, 1141-1144. doi: 10.1111/j.1532-5415.2012.03964.x

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



Suggested Citation:
and . Palliative Care - Interactive Patient Care Simulation. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/1101

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