The Portal of Geriatrics Online Education

Cognitive, Affective, and Behavioral Health

3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students

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

Background: Dementia, delirium, and depression are core minimum competencies outlined by the AAMC (Association of American Medical Colleges) for medical students by graduation. Focus groups with Hopkins’ medical students found that they had variable clinical experiences with 3Ds during neurology and psychiatry rotations and found it challenging to take a history from a patient with cognitive impairment.
Methods: A joint curriculum was established with psychiatry and neurology core clerkship directors for third and fourth year medical students. Pre-session: PowerPoint with information on 3Ds, mini-cog, 4AT, and PHQ-9. Using pre-recorded simulated videos, students completed worksheets and discussed in class. Additionally we incorporated an in person caregiver interview. We assessed students’ knowledge with in-class audience response questions, pre and post evaluations on how well learning objectives were addressed, and three month post didactic to assess behavior change. This curriculum will be repeated 4 more times during 2015-2016 academic year.
Results: In the first 3 quarters, 64 students completed didactic. Students scored 44-78% correct on 3/6 knowledge test questions (other 3 questions scored >90% correct). Students demonstrated most improvement in use and interpret mini-cog for dementia screen and 4AT for delirium screen as well as communication skills with patients and caregivers. No self-reported change pre and post didactic for students’ ability to differentiating between dementia and depression, or between dementia and delirium. Most importantly, a majority of students identified the importance of communicating with caregivers and providing support not only for the patient, but also for the caregiver. At three months follow up survey (75% completion rate), students identified communication techniques and understanding caregiver’s challenges as the most useful “take home” points from didactic.
Conclusions: Overall the 3D didactic was well received by medical students. They improved in identifying when to use screening tools for 3Ds, which may translate from knowledge to behavior at their next rotations. They also overwhelmingly identified the importance of communicating and assessing caregivers’ needs. More data will be collected during additional sessions this academic year. This curriculum could be easily disseminated without much additional resources.

Educational objectives: 

Knowledge & Skills objectives:
1. Recognize, compare and contrast  delirium, dementia, and depression in various clinical presentations.
2. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression by evaluating video interviews among patient, caregiver, and provider triad communication skills.
3.  Assess an older patient with delirium, initiate a diagnostic work-up to determine the root cause (etiology), by identifying predisposing factors and differential diagnosis of delirium, by utilizing  non pharmacologic strategies for delirium.
4. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function by demonstrating the ability to differentiate the result of 4AT (rapid assessment test of delirium) based on video interview of delirious patient.  Proficiency to use Mini-Mental Status Exam (MMSE)and mini-cog to determine cognitive impairment.

Program/process Objectives:
• ≥ 95% of medical students in neurology and psychiatry rotation will attend the dementia day.
• Of students who attended didactic in person, 100% of the medical students will have demonstrated the ability to distinguish dementia, delirium, and depression using worksheets based on video interviews.

 

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

AGS poster presentation 2016

AGS Educational Showcase 2016

Date posted: 
Tue, 07/26/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/26/2016
Contact Person/Corresponding Author:



Suggested Citation:
3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Postoperative Delirium Curriculum For General Surgery Residents

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

According to estimates, 50% of older adults will have an operation after the age of 65 with postoperative delirium being the most common complication in this age group. Even though delirium is common, the diagnosis is often overlooked and improperly treated. The American Geriatric Society surveyed surgical specialists and found that delirium was the geriatric clinical issue having the largest knowledge gap. Most surgical training programs still have little geriatric care incorporated explicitly into the curricula, and little explicit assessment of skills in caring for older patients. There is still a significant gap in formalized delirium education in surgical training programs. Our goal is to address this gap with this postoperative delirium curriculum for general surgery residents. Our objective is that through this geriatric surgical curriculum with a foundation consisting of delirium prevention, assessment, and management will ultimately lead to improved surgical care outcomes for older adults. This is a case based guide to compliment an online module through the Surgical Council of Resident Education (SCORE) website. We designed an online module on the SCORE website on postoperative delirium and this is an interactive case based small group exercise along with pre-post test, mini-cex, pocket card, and consultant check sheet. The case will require learners to go through a real surgical case, identify and modify risk factors, do delirium risk assessment, use a validated delirium screening tool (4AT), and come up with prevention and treatment options.

Educational objectives: 

After completion of the curriculum, the surgical resident will be able to:

  1. Identify the pathophysiological causes of postoperative delirium.
  2. Identify risk factors for the development of postoperative delirium.
  3. Recognize interventions to prevent postoperative delirium.
  4. Describe the common presentation of delirium and be able to distinguish delirium from dementia and depression.
  5. Recognize evidence based assessment tools (e.g. 3D CAM, 4AT, etc.) as reliable ways to screen for postoperative delirium.
  6. Describe the major effects that delirium has on surgical and patient outcomes.
  7. Correctly employed a validated delirium assessment tool (e.g. 4AT) to screen postoperative delirium in non-ICU older confused surgical patient.
  8. Calculate the correct delirium risk assessment score for a case scenario.
  9. Propose strategies for mitigating preoperative, intraoperative, and postoperative risk factors for a common general surgery case scenario.
  10. Identify "best-practice" non-pharmacologic and pharmacologic treatment strategies to manage postoperative delirium given a case scenario   
  11. Demonstrate to their attending or geriatric consultant the correct use of a validated delirium assessment tool to screen for postoperative delirium in non-ICU older confused surgical patient. 
  12. Perform prevention measures and monitor delirium development via evidence based assessment method (e.g 4AT) prior to geriatric consult.   

As a result of the curriculum, surgical residents will rate as important that surgeons should know:

1. Treatment strategies for postoperative delirium.

2. How to screen for postoperative delirium using a validated assessment tool.       

3. Strategies to prevent postoperative delirium.      

 

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

This was presented at the American Geriatricy Society Meeting and American Delirium Society Meeting.

Date posted: 
Wed, 02/13/2019
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/28/2019
Contact Person/Corresponding Author:



Suggested Citation:
Postoperative Delirium Curriculum For General Surgery Residents. POGOe - Portal of Geriatrics Online Education; 2019 Available from: https://pogoe.org/taxonomy/term/4826

Your Role in Delirium Detection and Treatment: An Interdisciplinary Approach

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Sponsors: 
Other Learning Resource Type: 
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
1
Abstract: 

This 24 minute video defines delirium and clarifies the role of each member of the acute care interdisciplinary team in detecting delirium and communicating with team members in the SBAR format (Situation, Background, Assessment and Request/Recommendation.)  The Confusion Assessment Method (CAM) is highlighted as the tool to use for delirium detection.  The video includes some voiceover with PowerPoint slides and a TeamSTEPPS video depictng a hospital nurse SBAR report to a provider on a patient with possible delirium. 

Educational objectives: 

Upon completion of this material, you will be able to:

  • Define and understand delirium and its significance in patient care.
  • Learn how to administer and interpret the Confusion Assessment Method (CAM.)
  • Define your role on an interdisciplinary team in caring for hospitalized patients with delirium.
  • Learn how to communicate effectively about delirium using SBAR (Situation, Background, Assessment, Request/Recommendation).

 

Date posted: 
Mon, 06/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/13/2016
Contact Person/Corresponding Author:



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

Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families

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

Discussing Cognitive Aging with Patients and Families is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Define cognitive aging
  2. Explain the difference between fluid intelligence and crystalized intelligence
  3. Identify a clinical test that can be used to assess speed of medical processing
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.  

Date posted: 
Thu, 06/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia

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

In 2012, 5.4 million Americans are diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internal medicine residents have a structured approach to the evaluation and management of BPSD.  This is the 3rd topic covered in a four part ambulatory geriatric curriculum that was developed for internal medicine residents.  To learn more about the successful ambulatory curriculum developed, please  check out  manuscript by Chang C1, Callahan EH, Hung WW, Thomas DC, Leipzig RM, DeCherrie LV. A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report. Gerontol Geriatr Educ. 2015 Jul 9:1-15.

Educational objectives: 

At the conclusion of this module, learners will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
    • Nonpharmacologic Interventions
    • Pharmacologic Interventions
Publications from, presentations from, and/or citations to this product: 

Christine Changab*, Eileen H. Callahanab, William W. Hungc, David C. Thomasb, Rosanne M. Leipzigab & Linda V. DeCherrieab A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report Gerontology & Geriatrics Education. Published online: 09 Jul 2015. DOI:10.1080/02701960.2015.1031897.

Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia

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

In 2012, 5.4 million Americans were diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internist have a structured approach to the evaluation and management of BPSD. 

Educational objectives: 

Participants will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

Geriatricized H&P with Function and Delirium Risk Assessments

:  
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: 

One important goal of the Wake Forest Geriatrics Principles for Specialists program is to train faculty, chief residents and fellows in the use of quality improvement techniques to enhance care for older adult patients that they serve.  As a product of this effort, chief residents and their faculty mentors in General Internal Medicine developed functional assessment and delirium risk assessment tools that have been incorporated into the history and physical template of the electronic medical record (EMR) to identify pre-hospital functional and cognitive limitations that affect admitted patients age 65 or older.  At present these tools are found in the note template of the following services: four general medicine teaching services, two cardiology services, the renal service, the hematology oncology service, the leukemia service, the Acute Care for the Elderly service, the cardiac critical care service, and the medical intensive care service. 

The functional assessment, implemented in July 2014, includes four questions to help determine a patient’s baseline functional status, including ability to complete activities of daily living and independent activities of daily living, ambulation status, and pre-hospital residence.  Analysis involving chart reviews pre-and post- functional assessment tool implementation showed increased documentation of functional history data in the EMR. 

The delirium risk assessment, implemented in July 2015, includes four items to help identify a patient’s cognitive status, including age greater than 80, a reverse spelling task, orientation to location, and illness severity.  Analysis of delirium incidence of hospitalized patients pre- and post- delirium risk tool implementation is planned for fall 2015.  Our hypothesis is that delirium incidence will rise as awareness and watchfulness by providers increases with use of the tool. 

While the results of implementing these physical and cognitive assessment tools are preliminary or still in process, anecdotal feedback received from case managers and other stakeholders in the discharge planning process indicate that they find such information incorporated in the H&P by admitting physicians to be valuable.  Further study is needed to determine whether such documentation expedites discharge planning, improves use of therapy services, or improves readmission rates or morbidity outcomes.  Next steps planned beyond testing of the delirium assessment tool include implementing a delirium prevention order set to standardize measures taken to decrease delirium among inpatients, followed by further evaluation of changes in delirium incidence, and eventual implementation of a delirium management order set.  The success of these measures within Internal Medicine could encourage roll-out of these tools institution-wide.

An additional benefit of this effort has been the educational value of supporting the training of residents in informatics so that they can contribute to developing solutions for improving patient safety and quality of care.  

Educational objectives: 
  1. To train residents and faculty in quality improvement techniques for the purpose of enhancing quality of care and patient safety for older adult patients.
  2. To involve residents in developing EMR tools that emphasize the importance of physical and cognitive assessments when admitting older adult patients to the hospital.
  3. To provide training opportunities in EMR informatics for residents and junior faculty.
Publications from, presentations from, and/or citations to this product: 

M. Wesley Milks, Farra Wilson, Ajay Dharod and Kirsten Feiereisel.  Abstract 347:  Identification of Functional Limitations on Admission by Internal Medicine Resident Physicians.  Circulation: Cardiovascular Quality and Outcomes. 2015;8:A347.

Contact Person/Corresponding Author:



Suggested Citation:
Geriatricized H&P with Function and Delirium Risk Assessments. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/4826

Assessing Capability of Medical Decision Making Capacity

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

A multifacted program focused on Assessment of Medical Decision Making Capacity. It includes the following education and assessment tools:

 

  • Elder Care Provider Sheet, “Medical Decision-Making Capacity”
  • A needs assessment for all medical and surgical specialties
  • Just-in-time reference cards
  • Mini-CEX to assess residents

 

Educational objectives: 

Determine if the patient has the:

  • Ability to clearly communicate their choice for treatment or non-treatment
  • Ability to understand the relevant information (regarding medical condition and treatment)
  • Ability to understand the situation and the consequences of treatment options
  • Ability to reason about treatment choices, consistent with personal values

 

 

Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.               

Date posted: 
Mon, 09/28/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/29/2018
Contact Person/Corresponding Author:



Suggested Citation:
Assessing Capability of Medical Decision Making Capacity. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/4826

Vascular Influences on Late-Life Depression

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

This one hour video lecture with accompanying PowerPoint slides provides an overview of vascular disease in late life depression. The target audience is Interdisciplinary Health Care Professionals.

Educational objectives: 

Upon completion of this material you will be able to:

  • Identify the relationship between vascular disease and late-life depression.
  • Identify theories on how vascular disease may contribute to depression.
Additional information/Special implementation requirements or guidelines: 

This material is from the Geriatrics and Gerontology Interest Groups (GGIG) of Vanderbilt University

Date posted: 
Mon, 03/21/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 03/21/2016
Contact Person/Corresponding Author:



Suggested Citation:
Vascular Influences on Late-Life Depression. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4826

End Stage Dementia

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

This one hour video lecture with accompanying PowerPoint slides provides an overview advanced dementia and how to better prepare patients and families before the disease progresses to end stage. The target audience is Interdisciplinary Health Care Professionals. 

Educational objectives: 

Upon completion of this video lecture, you will be able to:

  • Recognize the signs of end stage dementia and know what medications are not recommended in end stage dementia.
  • Discuss the benefits and risks of tube feeds in dementia patients.

 

Additional information/Special implementation requirements or guidelines: 

This material is from the Geriatrics and Gerontology Interest Groups (GGIG) of Vanderbilt University

Date posted: 
Wed, 03/23/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 03/23/2016
Contact Person/Corresponding Author:



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

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