The Portal of Geriatrics Online Education

Cognitive, Affective, and Behavioral Health

Frailty Interactive Cases and A Facilitator’s Guide

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

Introduction: Frailty is a diagnosable and treatable medical condition. It is a common syndrome in older adults, characterized by: physiological decline, marked vulnerability to adverse health outcomes, increased healthcare utilization, disability, high risk of falls, multiple comorbidities, and mortality. Our goal was to create a case-based educational resource in frailty for medical and other healthcare students.

Methods: A multidisciplinary team at the Miami VAHS, Geriatric Research Educational and Clinical Center, designed and implemented an 8-module educational resource on frailty: An Introduction and 7 cases covering screening, diagnosis, management, and comorbidities. This curriculum was used and evaluated by 4th-year medical students from the University of Miami Miller School of Medicine. Evaluation included a pre-/post-test and a curriculum evaluation with questions on content, learning objectives, value of the learning, and multimedia module usability. The Wilcoxon signed rank test was used with unilateral Monte Carlo significance to compare pre-/post-test performance, significant at p<.05.

Results: Fifty-one students completed 4 modules and the pre-/post-test from November 2020 to March 2021. Students’ post-test performance demonstrated significant improvement (p<.05) in knowledge of frailty. Fifty-five percent agreed the multimedia educational activity enhanced their knowledge of frailty and will include frailty assessment in their future practices. The combined “Good + Excellent” rating from evaluations of content linked to learning objectives ranged from 82.3-94.2%. Overall, written comments were positive regarding multimedia usability.

Conclusion: These case-based modules on frailty were highly rated and positively critiqued by students. Pre-/post-test evaluations demonstrated an increase in knowledge of frailty.

Keywords

Frailty, sarcopenia, comorbidities, multimedia, case-based learning

Educational objectives: 

There are twelve (12) learning objectives for the seven (7) cases; two learning objectives repeat for multiple cases. The number(s) in parentheses at the end of each learning objective below designates the cases in which the learning objective applies. All learning objectives start with the statement, “After viewing this module, learners will be able to describe.”

  1. Frailty can be diagnosed using accepted criteria and available tools (1)
  2. Frailty can be managed with literature-based interventions that include exercise nutritional support and optimized treatment of comorbid conditions (1)
  3. Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional (2 through 7)
  4. Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination (2)
  5. As is often the case in caring for patients with complex disease, it takes a team (2, 3, 6, 7)
  6. Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains (3)
  7. Frailty is often associated with dependency and the need to recommend palliative care (4)
  8. Frailty is often associated with depression because both are common diseases (5)
  9. Depression can affect frailty by amplifying the symptoms of co-morbid conditions (5)
  10. Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function (6)
  11. The need to customized cancer care in frail patients based on comorbidities, function and prognosis (7)
  12. The importance of the social domain in care planning for patients with frailty and cancer (7)
Additional information/Special implementation requirements or guidelines: 

 

Facilitator’s Guide

Understanding Frailty: Screening, Diagnosis and Management

Authors

Lubna A. Nasr, MD

Department of Public Health, University of Miami Miller School of Medicine

Bruce W. Carter Miami VAMC, Miami, FL, USA

Raquel Aparicio-Ugarriza, PhD

ImFINE Research Group. Faculty of Physical Activity and Sport Science-INEF

Universidad Politécnica de Madrid, Madrid, Spain

Douglas Salguero, MD

Mount Sinai Medical Center, Miami, FL, USA.

Michael J. Mintzer, MD, AGSF

Director and Associate Director for Education & Evaluation

Miami Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA

Acknowledgements

The authors would like to thank:

Rose van Zuilen, PhD, and Corinne B. Ferrari for their help in reviewing the modules and including this frailty training as a component of the MS4 geriatrics clerkship

 

Overview

Frailty is a term widely used in clinical medicine but often ill-defined. The primary purpose of these modules is to teach learners the definition, screening modalities and diagnostic methods for frailty. In addition, the secondary purpose to is display healthcare issues of older adults commonly associated with frailty. These include comorbid conditions, social disruptions, end-of-life care, etc.

This training is composed of eight PowerPoint narrated and animated presentations. PowerPoint was chosen because of its ubiquitous availability to virtually all learners. The introduction presents the basics of frailty definition, screening and diagnosis. The subsequent seven case-based modules ask students to apply their knowledge. We recommend that learners complete a minimum of four modules starting with the introduction and ending with Case 7; learners are free to choose two modules from cases 1 through 6 and are welcome to complete all these optional cases. Finally, case 7 is the most complicated and longest module; if a learner uses the fully narrated and animated features, it will run approximately 25-minutes. To meet individual needs, learners have the option to disable audio (narration and dialog) on some or all of the screens. (These PowerPoint-based modules do not provide the option of varying the speed of audio tracks as in some programs). Most students can complete the minimum of 4 modules in 60-75 minutes; all the modules can be completed in 2-2.5 hours. The list of module titles is included in Learning Objectives below.

All cases use a standardized template. Navigation instructions are included in the Introduction; all cases follow the same instructions. Learners must start with the Introduction followed by cases in numerical sequence; cases become more complex with progression. In evaluating this curriculum, we used: Introduction, followed by Case 1, Case 5 and Case 7. Students can return to the Introduction module at anytime to review terms and definitions.

Materials and Supplies

Access to a computer with Microsoft PowerPoint or other compatible software is required. Headphones or earbuds may be needed if learning is occurring in a congregate environment or because of learner preference. This training requires no other special instructions, materials or supplies. The PowerPoint presentations can be easily uploaded to the school’s learning management system for assignment to learners.

Learning Objectives

Learning objectives are included in each case. These objectives also act as a “preview” for the content within the animated and interactive modules. The introduction has no learning objectives because it is a “definition of terms” module for frailty, sarcopenia, and frailty screening, diagnosis and management. These topics are specifically addressed within the learning objectives of the cases. There are 12 unique learning objectives. Some of the learning objectives appear in more than one case. This is intentional. It allows learners to apply their learning to a new clinical circumstance or a new domain of care. The learning objectives follow the statement, “After viewing this module, learners will be able to describe:” and are listed here by case:

Case 1: Mild Frailty

  • Frailty can be diagnosed using accepted criteria and available tools
  • Frailty can be managed with literature-based interventions that include exercise, nutritional support and optimized treatment of comorbid conditions

Case 2: Moderate Frailty and Falling

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination
  • As is often the case in caring for patients with complex disease, it takes a team

Case 3: Frailty and Cognitive Symptoms

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains
  • As is often the case in caring for patients with complex disease, it takes a team

Case 4: Severe Frailty, Dependency and Palliative Care

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with dependency and the need to recommend palliative care

Case 5: Frailty and Depression

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with depression because both are common diseases
  • Depression can affect frailty by amplifying the symptoms of co-morbid conditions

Case 6: Frailty and Major Neurocognitive Disorder

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function
  • As is often the case in caring for patients with complex disease, it takes a team

Case 7: Frailty and Cancer

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • The need to customized cancer care in frail patients based on comorbidities, function and prognosis
  • The importance of the social domain in care planning for patients with frailty and cancer
  • As is often the case in caring for patients with complex disease, it takes a team

Evaluation

During this curriculum evaluation, we used identical pre- and post-tests, containing seven questions with twenty correct answers, to measure learning. This pre-/post-test is available upon request. All questions were effective in discriminating an increase in learning. Learner comments on content, presentation and usability of the modules were overwhelmingly positive.

Use of These Modules

These modules are free for use for all teachers, instructors and trainers. They can be used as produced and be incorporated into an existing curriculum, in part or in full. When these frailty modules are used or included in another curriculum, questions from the pre-/post-test may be adapted for assessments of students’ learning. As with all student assessments, these questions would likely require revision after several years of use. If adapted versions of this curriculum, or parts of this curriculum, are published, attribution to original authors must be included and these new materials must be equally accessible to teachers, instructors and trainers as are the original materials. These materials may not be used or adapted for commercial purposes. (See Creative Commons criteria: CC BY-NC-SA [Attribution-NonCommercial-ShareAlike]).

Date posted: 
Wed, 08/11/2021
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 06/09/2021
Contact Person/Corresponding Author:



Suggested Citation:
Frailty Interactive Cases and A Facilitator’s Guide. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/4826

Office - Based Geriatrics Assessment

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

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

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



Suggested Citation:
Office - Based Geriatrics Assessment. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/4826

Simulation Curriculum for Geriatric Medicine Fellows

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

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

Educational objectives: 

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

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

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

Additional information/Special implementation requirements or guidelines: 

n/a

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

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

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



Suggested Citation:
Simulation Curriculum for Geriatric Medicine Fellows. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4826

ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS

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

This case study was developed for use in academic coursework and as a standalone training for health care providers (MDs, ARNP, Pharmacists, Social Workers, Nurses). This unfolding case study about the management of an older adult in the midst of a health crisis. This case is a composite of many actual cases seen in Emergency Departments. During the course of this case study, learners are presented with information as the providers learn of the patient’s emergent and ongoing health concerns – from her Emergency Department admission through her Intensive Care Unit stay. Learners are asked to make decisions and use their best judgment about how to care for this patient.

Educational objectives: 

 

  • Apply knowledge of evidence-based care provision to an older adult found with altered mental status after a ground level fall
  • Describe the contributions of the interprofessional team to care management
  • Demonstrate effective communication during handoffs in care
Publications from, presentations from, and/or citations to this product: 

Citations are listed at the bottom of the screen throughout the case study.

Date posted: 
Fri, 07/27/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 05/22/2018
Contact Person/Corresponding Author:



Suggested Citation:
ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4826

Mini-Cog Clinical Evaluation Exercise (Mini-CEX)

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

This Mini-Cog Clinical Evaluation Exercise (Mini-CEX) is a revision of the Ehrlich and Freeman's (2011) Clinical Evaluation Exercise (Mini CEX) Mini-Cog with the addition of assessing if there was time in communication of the test with patients and families. It is designed to use with a learner during an actual patient encounter. The teacher observes the learner during the patient encounter and completes the form. The teacher then reviews the form with the learner and provides feedback of what skills were observed, partially observed, not observed, not applicable and comments about the encounter.

Educational objectives: 

The learner who is administered this Mini-Cog Mini-CEX will:

1)be observed performing a Mini-Cog with a patient.

2)receive feedback about their Mini-Cog clinical skills and communcation skill with patients.

3)obtain a record of their clinical skill in performing a cognitive sceening using Mini-Cog.

Date posted: 
Mon, 01/23/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/23/2017
Contact Person/Corresponding Author:



Suggested Citation:
Mini-Cog Clinical Evaluation Exercise (Mini-CEX). POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/4826

Your Role in Dementia Detection and Treatment: An Interdisciplinary Approach

:  
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 30 minute "Concepts in Common" video synthesizes the key aspects of dementia from an interdisciplinary approach. All team members, including the patient and family, need to have a common understanding of key terms and each's role from a common framework.  Communicating using SBAR (Situation, Background, Assessment, Request/Recommendation)  is essential and clarified with a "Role Map."

Educational objectives: 

- Define and understand dementia and its significance in patient care

- Learn how to administer and interpret the Mini-Cog

- Define your role on an interdisciplinary team in caring for patients with dementia

- Learn how to communicate effectively about dementia using SBAR

 

Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Your Role in Dementia Detection and Treatment: An Interdisciplinary Approach. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

The Hospitalized Older Adult

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

Older adults are exposed to multiple hazards during hospitalization resulting in multiple complications that limit their return to their functional and cognitive baseline. It is critical that healthcare providers are trained on best practices in the care of hospitalized older adults. This product is a monthlong module for M4 students during their Sub I rotation, that focuses on educating them on the hazards of hospitalization, best practices in the care of hospitalized older adults, issues that occur during transitions of care and best practices to ensure optimal transitions across care settings. The module starts with an initial lecture on hazards of hospitalization and best practices in the care of older adults. This is followed by assignments in which students are assigned older aduts to care for. Using a checklist, they evaluate the care that these patients have received and also implement best practices in the care of their patient. They also participate in an interdisciplinary team meeting that focuses on these aspects of care.  This is followed by another assignment in which they are involved in deciding on the most appropriate discharge care setting their patient. They subsequently place a post discharge call to their patient to identify any issues thay may have encountered post discharge and assist them in resolving some of these issues. Through the month, students share their experiences on blackboard, outlining hazards they identified in their patients,  challenges in implementing best practices, choice of discharge care setting and reasons for their choices along with care transitions issues identified in their patients. Additionally they are required to review educational materials and published articles posted on blackboard, focused on hazards of hospitalization, best practices in care, settings of care and transitions of care.  A final class is held with the students at the end of the month discussing the rotation and their experiences, with a focus on settings of care and best practices in transitions of care.

Educational objectives: 

At the end of this course, each participant will be able to:

1. Describe the hazards of hospitalization of older adults.

2. Evaluate the care and implement best practices in the management of a hospitalized older adult.

3. Enumerate the discharge options available in a particular case scenario.

4. Compare and contrast the problematic elements of care transition with those of an ideal care transition.

Date posted: 
Tue, 10/25/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/25/2016
Contact Person/Corresponding Author:



Suggested Citation:
The Hospitalized Older Adult. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Geriatrics Self Learning Tools For Residents

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

The enclosed materials are learning tools developed to help medical residents on the geriatrics rotation at Montefiore Medical Center master delirium screening, dementia screening and falls risk evaluation. Each tool consists of a short description of the definition and epidemiology of the respective syndrome followed by a screening instrument for the syndrome. Residents are given the tools at the start of the rotation and are asked to practice each of the assessments on at least two patients. To ensure that they receive feedback on their performance of the assessment, the residents are given a log sheet for preceptors to fill out after each assessment. Logs are reviewed at the end of the rotation. Residents are also given a reading packet at the start of the rotation with more in depth information on the above topics as well as other geriatrics topics.  

Educational objectives: 

Learners will review knowledge of dementia, falls and delirium.

Learners will gain the ability to perform assessments for dementia, falls and delirium 

Additional information/Special implementation requirements or guidelines: 

Permission pending for use of the 3DCAM

Date posted: 
Tue, 10/18/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/19/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatrics Self Learning Tools For Residents. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Interdisciplinary Health Profession Module Videos

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

Care teams often don't know how to effectively and efficiently collaborate when addressing a patient’s health. Depending on a patient’s needs, team leadership can shift at any given moment from one person to another. Because of this constant jockeying and adaptation, educating learners about their own interprofessional relationships is becoming incredibly important. These videos and the corresponding text supplements provide a context for interprofessional team members to discover more about what it takes to become a member of another profession. This knowledge, combined with their own experiences and clinical practice, will assist in preparing learners for the next-generation of team-based healthcare.

Educational objectives: 

After watching these short 2-3 minute videos, interprofessional teams will be able to contextualize their own relationship within the group dynamic, understand the educational requirements that go into other disciplines, and formulate an effective team-based learning approach for future activities.

Date posted: 
Tue, 09/27/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/27/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interdisciplinary Health Profession Module Videos. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

VirginiaGeriatrics.Org

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

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

Educational objectives: 

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

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



Suggested Citation:
VirginiaGeriatrics.Org. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

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