The Portal of Geriatrics Online Education

17 ATYP: Identify 3 physiologic changes for each organ system

17. For each organ system identify at least 3 changes of normal aging (e.g., normal labs for older adults) and their impact on the patient, including their contribution to homeostenosis (the age-related narrowing of homeostatic reserve mechanisms). Know when clinical signs and presentations are normal aging and not disease.

Geriatric Nephrology OSCE

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

At the Medical College of Wisconsin (MCW), geriatricians, nephrologists and medical educators worked together to create and implement a geriatric nephrology OSCE for nephrology fellows. Key curriculum content gaps (pathophysiology of the aging kidney, medication and renal dosing and renal toxicity in elderly patients) were identified through a needs assessment including:

  1. ACGME nephrology requirements
  2. Nephrology fellows' in-service exam scores
  3. Survey of fellows and faculty to identify areas of perceived weakness
  4. Literature review, and
  5. Brief MCQ of basic science linked to clinical case questions.

Curriculum content was delivered using the Objective Structured Clinical Examination (OSCE) educational / assessment method. The curriculum session highlighted kidney injury and pharmacology topics: drug toxicity + underlying science through an OSCE session with post session debriefing provided by faculty. Fellows were evaluated by faculty and standardized patients using a checklist, and fellows evaluated the session at its completion. This submission contains all materials for the geriatric nephrology OSCE session.

Educational objectives: 

1. Demonstrate competence in the prevention, evaluation and management of geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract.

2. Apply knowledge of physiology and pathology of the aging kidney + drug dosing and renal toxicity in the elderly patient.

3. When called as a consultant, to quickly: a. Identify signs of adverse drug reactions (drug overdose/toxicity) in an elderly patient and, b. Communicate a management plan to the patient and family.

Additional information/Special implementation requirements or guidelines: 

Additional details may be found in the detailed Instructors' Guide included in the submission.

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

Denson K, Manzi G, Foy P, Vasudev B, Malmsten C, Rehm J, Brown D, Simpson D, Duthie E, Using Teaching Objective Structured Clinical Examination (OSCEs) to Expand Fellows' Perceptions Around Quality Care for Older Adults, American Geriatrics Society Annual Meeting, Orlando, FL 04/2014.

Date posted: 
Fri, 09/25/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 09/25/2015
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Nephrology OSCE. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/124

Anatomy Image Atlas of Aging: Liver

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

The Image Atlas of Aging is an original UMMS educational product developed to highlight the normal age-related anatomic and histological changes within the digestive system. The Image Atlas of Aging is a PowerPoint module that features normal gross and histological images to model the aging liver and to serve as an easily replicated prototype to eventually incorporate other organs and organ systems. The module introduces the principle of homeostenosis as a function of aging that emphasizes that aging is neither equivalent to disease nor does it signify inevitable disease. This original geriatrics content has been integrated into the first year medical student “Development, Structure, and Function” (DSF) course curriculum.

Educational objectives: 

After completion of this module, the MS1 learner will be expected to:

  • explain that liver disease is not a part of normal aging
  • differentiate normal anatomic, physiologic, and histological differences between the young and aged liver
  • define the principle of homeostenosis, illustrating how the hepatic portal system becomes more susceptible to acute injury with the loss of age-related functional reserve
Additional information/Special implementation requirements or guidelines: 

Formal on-going discussions are held with the UMMS Development, Structure, and Function (DSF) course directors, who review the modules to strategize best integration to the DSF curriulum. Additionally, UMMS geriatricians teach from the Image Atlas modules in the anatomy lab each fall.

Date posted: 
Fri, 10/11/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/11/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , and . Anatomy Image Atlas of Aging: Liver. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/124

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/124

"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/124

Anatomy Image Atlas on Aging: Heart

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

The Image Atlas of Aging is an original UMMS educational product developed to highlight the normal age-related anatomic and histological changes within the cardiovascular system. The Image Atlas of Aging is a PowerPoint module that features normal gross and histological images to model the aging heart and to serve as an easily replicated prototype to eventually incorporate other organs and organ systems. The module introduces the principle of homeostenosis as a function of aging that emphasizes that aging is neither equivalent to disease nor does it signify inevitable disease. This original geriatrics content has been integrated into the first year medical student “Development, Structure, and Function” (DSF) course curriculum.

Educational objectives: 

After completion of this module, the MS1 learner will be expected to:

  • explain that cardiovascular disease is not inevitable with normal aging
  • differentiate normal anatomic, physiologic, and histological differences between the young and aged heart
  • define the principle of homeostenosis, illustrating how the renal system becomes more susceptible to acute injury with the loss of age-related functional reserve
Date posted: 
Tue, 05/20/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 05/20/2014
Contact Person/Corresponding Author:



Suggested Citation:
, , , and . Anatomy Image Atlas on Aging: Heart. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/124

Osteoporosis Educational Series

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

This three-part lecture series provides an overview of  topics related to the elderly and osteoporosis. The lectures are designed to be presented in sequence and illustrate learning principles developed for residents but suitable for a variety of learner levels.

Lecture one: A Public Health Problem of Older Age

Lecture two: Pathogenesis and Risk Factors

Lecture three: Treatment and Prevention

Educational objectives: 

Lecture one:

  1. Define osteoporosis
  2. Describe the health impact of osteoporotic fractures from an individual to health care system level.
  3. Identify the generally recommended DEXA site to diagnose osteoporosis.

Lecture two:

  1. Explain normal and abnormal state of bone metabolism
  2. Define bone remodeling
  3. Identify risk factors for bone loss
  4. Calculate risk of facture

Lecture three:

  1. Characterize the pathophysiology of osteoporosis
  2. Identify the clinical diagnosis of osteoporosis
  3. Summarize treatment and prevention options
Additional information/Special implementation requirements or guidelines: 

Speaker notes are embedded within the PowerPoint Presentation.

Date posted: 
Thu, 08/08/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 08/08/2013
Contact Person/Corresponding Author:



Suggested Citation:
Osteoporosis Educational Series. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/124

ElderQuest

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

ElderQuest is an interactive 3-D videogame aimed at helping medical students learn the AAMC geriatric competencies. The first 5-mission playpack of a single-player game has been completed, during which the player starts a journey to save the Grey Sage and the Kingdom from various hazards. Game content reinforces medication management, cognitive disorders, falls, self-care capacity and atypical presentation of disease. Key members of the geriatrics team are integrated into the game and storyline in order to illustrate the interprofessional team-based model for geriatric care. Educational metrics measuring geriatrics content and learner performance are mapped to specific AAMC competency areas and programmed to generate in-game feedback to the player as they accomplish each mission. An example screenshot of a player debriefing screen is provided. A survey to evaluate student acceptance of video gaming as a learning tool has been developed and is also provided.

Educational objectives: 
  1. Use first-person interactive game play,  competition  and immediate player feedback to acquire competition geriatrics content knowledge and guide self-improvement.
  2. Apply AAMC geriatric competencies related to medication management, cognitive disorders, falls, self-care capacity and atypical presentation of disease to game challenges
  3. Improve retention of geriatrics content knowledge acquired about AAMC geriatric competencies. Improve retention of geriatrics content knowledge acquired about AAMC geriatric competenImprove retention of and proficiency in AAMC geriatric competencies linked to game play success. 
Additional information/Special implementation requirements or guidelines: 

Live internet access by a computer with traditional keys and a mouse is required to 1) access the website which hosts the game and 2) execute game commands. You must download and install the free Unity game engine in order to play.

Measurement of specific student performance data other than general in-game debriefing screens for the player, such as item performance and time spent in game,  requires contracting with the game developer, Brainstorm Rising, LLC, for a site-specific database. Game progress may be saved at the end of any mission by the player. The game may be played multiple times in multiple sessions for as long as desired. In-game help is available for geriatrics content knowledge related to the game. 

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

Pomidor A, Pomidor B, Granville L, Brummel-Smith K, Baker S. ElderQuest: Video Game Fun with the AAMC Competencies. Poster presented at the 2011 American Geriatrics Society Annual Scientific Meeting, May 12, 2011, National Harbor, MD. 

2011 American Geriatrics Society Annual Scientific Meeting, National Harbor, MD.  Model Geriatric Programs: Geriatric Education Materials and Methods Swap. “ElderQuest: Video Game Fun with the AAMC Competencies” May 12, 2011. 

Harris S. Video Games as Medical Education Tools.  AAMC Reporter. June 2011. https://www.aamc.org/newsroom/reporter/june2011/250894/games.html Acc

Accessed , accessed  

 

Date posted: 
Fri, 06/08/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/08/2012
Contact Person/Corresponding Author:



Suggested Citation:
ElderQuest. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/124

Anatomy Image Atlas on Aging: Kidney

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

The Image Atlas of Aging is an original UMMS educational product developed to highlight the normal age-related anatomic and histological changes within the renal system. The Image Atlas of Aging is a PowerPoint module that features normal gross and histological images to model the aging kidney – and to serve as an easily replicated prototype to eventually incorporate other organs and organ systems. The module introduces the principle of homeostenosis as a function of aging that emphasizes that aging is neither equivalent to disease nor does it signify inevitable disease. This original geriatrics content has been integrated into the first year medical student “Development, Structure, and Function” (DSF) course curriculum. This product contains two versions of the lecture: the complete presentation intended for the educator and the shortened student module. 

 

Educational objectives: 

After completion of their DSF course, the MS1 learner will be expected to:

  1. Explain that renal disease is not inevitable with normal aging
  2. Differentiate normal anatomic, physiologic, and histological differences between the young and aged kidney
  3. Define the principle of homeostenosis, illustrating how the renal system becomes more susceptible to acute injury with the loss of age-related functional reserve
Additional information/Special implementation requirements or guidelines: 

There is a dearth of existing available educational resources that pictorially contrast normal age-related anatomic and histological organ system changes. (Most of the available resources demonstrate normal versus pathologic.)

Pivotal to Image Atlas completion was developing partnerships with the UMMS pathology department and anatomy and cell biology division. UMMS' Advancing Geriatrics Education (AGE)/Reynolds summer student, UMMS MS2 Patrick Bonavitacola, forged new working relationships with the director of surgical pathology and renal pathology, the current chief resident, and the co-director of the MS1 DSF course. Existing images were culled from: 1) the former chief of pathology's legacy slide collection within the UMMS pathology department, 2) dissections in the anatomy lab; and 3) recent autopsies in the pathology lab. Images were also incorporated from local textbooks and an image database taken with permission from the University of Connecticut.

Formal discussions have been held with the DSF course directors, who are currently reviewing the PowerPoint module and strategizing  how to best integrate this model and original content into the DSF curriulum. UMMS geriatricians will teach from this curriculum in the anatomy lab this fall.

Date posted: 
Mon, 05/13/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 05/13/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , and . Anatomy Image Atlas on Aging: Kidney. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/124

Urinary Incontinence OSCE

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

An OSCE examination was developed that evaluates assessment and evaluation of a geriatric patient suffering from urinary incontinence.  The OSCE allows for evaluation of communication and history taking skills as well as for a focused physical examination.   A voiding diary is reviewed with assessment of this diary completed.  A differential diagnosis must be given along with a detailed evaluation and treatment plan.  In addition, basic knowledge of bladder function and incontinence is assessed.

Educational objectives: 

 

1.      To evaluate the learner’s ability to effectively communicate with a geriatric patient and obtain a thorough history.

2.      To assess the learner’s ability to interpret a voiding diary.

3.      To assess the learner’s differential diagnosis regarding urinary incontinence.

4.      To evoke an effective and appropriate evaluation and treatment plan from the learner.

Date posted: 
Fri, 06/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Urinary Incontinence OSCE. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/124

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