The Portal of Geriatrics Online Education

8 CBD: Evaluate and manage agitated patients

8. Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients.

2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies

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

In 2010, the essential geriatric competencies for Internal Medicine (IM) and Family Medicine (FM) residents were published. To reinforce and disseminate these critical skills, we created a quick reference mobile application for IM and FM residents that addresses competencies in each of the seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.

This application can be used as a comprehensive reference by learners of multiple levels and disciplines while caring for patients in a variety of settings, including inpatient wards, outpatient clinic, nursing homes and home visits. Various screening tools, criteria, mnemonics and guidelines supporting each competency are included in this concise guide to caring for aging adults.

To access the free app:

  1. Go to Geriatrics Quick Reference App on AgileMD
  2. Create a free AgileMD account  
  3. Download the free AgileMD application using your smartphone app store 
  4. Open the AgileMD app and login with the username and password you created
Educational objectives: 
After using this quick reference tool, learners will be able to:
1.) Select and apply evidence-based tools to screen for or assess geriatric syndromes.
2.) Asses for and manage issues affecting older adult health across seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.
Publications from, presentations from, and/or citations to this product: 

AGS 2015 Educational Showcase Product Swap

Date posted: 
Mon, 09/28/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 04/03/2018
Contact Person/Corresponding Author:



Suggested Citation:
2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/85

Evaluation and Management of Late Life Psychosis

:  
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, web-based, interactive educational module addresses the evaluation and management of psychosis in older adults.

Educational objectives: 

After reviewing this module, learners should be able to:

1) list examples of psychotic symptoms.

2) describe the steps involved in performing a diagnostic work-up.

3) summarize treatment principles.

Additional information/Special implementation requirements or guidelines: 

Author:  Mary Camp, MD

Geriarician:  Amit Shah, MD

Medical Illustrator:  Lindsay Oksenberg, MA

Date posted: 
Tue, 01/20/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/20/2015
Contact Person/Corresponding Author:



Suggested Citation:
Evaluation and Management of Late Life Psychosis. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/85

An Inter-Professional Education Delirium Simulation Pilot Project

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

Case Overview: Ida Mae Homer is an 80 year-old woman with a 5-year history of Alzheimer’s disease.  Her granddaughter has been staying with her for the last 3 days while her daughter (her usual caregiver) is out of town.  Mrs. Homer is becoming increasingly confused and agitated with increased urinary frequency and incontinence as well as insomnia.  Her granddaughter has tried using Benadryl to help her sleep, however nothing seems to be helping.

Simulation: The set-up for the simulation includes the medical and nursing students reviewing a delirium web module (POGOe #20503) as well as a Situation, Background, Assessment, Recommendation (SBAR) video attached on the right side of this page, then completing pre-test delirium assessment (Delirium Knowledge Survey) and an assessment of attitudes toward teams in training (KidSIM) prior to the simulation.  Next, each medical and nursing student pair meets approximately 10 minutes prior to the simulation to review instructions, introduce themselves, and discuss thoughts and plans for caring for an agitated patient.  The team is then escorted to the “Emergency Room” where the patient and granddaughter (both are standardized patients) are waiting (faculty observes from control room).  The patient is agitated and anxious and is trying to get out of bed.  The team should elicit information from the granddaughter and recognize that the use of Benadryl and the probable urinary tract infection are the likely etiologies of delirium.  The team has a variety of medications available on the med cart (lorazepam, haloperidol, morphine, and hydroxyzine) as well as restraints, and the patient has “IV” access.  The simulation lasts 20 minutes, and approximately 10-15 minutes into the simulation, once the patient is stable and a plan has been established, the medical student calls the “attending” in the control room, and using SBAR, checks out the patient over the phone.  The faculty member then ends the simulation, and the entire team (faculty member, 2 students, and 2 standardized patients) leave the room for an approximately 15-20 minute debriefing session.  Simulations can run staggered if there are resources to have 2 teams and 2 standardized patients, otherwise the next simulation would begin once the debriefing session ends.

Goals for the simulation and topics for discussion during debriefing session:

  1. Diagnose delirium using CAM
  2. Identify potential causes for delirium
  3. Identify appropriate pharmacologic management for delirium (medication as well as dosage)
  4. Inter-professional collaborative practice
  5. Situation, Background, Assessment, Recommendation (SBAR)
Educational objectives: 
  1. The students will be able to evaluate a patient with agitated delirium.
  2. The students will be able to outline appropriate treatment for a patient with delirium.
  3. The students will be able to work effectively with students in other professions in the care of a patient with agitated delirium.
  4. The students will be able to achieve 80% on post-test Delirium Survey.
  5. The students will improve their attitudes and beliefs about teams in training (KidSIM).
Publications from, presentations from, and/or citations to this product: 

The results of this inter-professional education delirium simulation has been presented at the American Academy of Neurology's Consortium of Neurology Clerkship Director's annual meeting, highlighting educational tools.  The results have also been presented at the Johnson County Community College's Annual Healthcare Simulation Conference.  This pilot project has also served as preliminary data for the University of Kansas' successful Reynold’s Foundation Next Steps grant application.

Date posted: 
Mon, 09/29/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/29/2014
Contact Person/Corresponding Author:



Suggested Citation:
An Inter-Professional Education Delirium Simulation Pilot Project. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/85

Dementia & Delirium TBL

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

This program is a team based learning program we use with our third year medical students in our longitudinal integrated curriculum. Both the facilitator and student version are included. The IRAT and GRAT cover broad areas of dementia and delirium including the diagnosis of postoperative delirium in a patient with dementia, interventions to prevent & treat delirium, outcomes of delirium, the pharmacologic treatment of Alzheimer’s disease, distinguishing mild cognitive impairment from Alzheimer’s disease, and the principles of comprehensive care for dementia patients. The application exercise is a case which requires synthesis and analysis as a team and requires considerations in comprehensive care of the patient.

Educational objectives: 

After completing this material you will be able to:

  1. Diagnose postoperative delirium in a patient with dementia.
  2. Describe interventions to prevent & treat delirium.
  3. Describe outcomes of delirium.
  4. Understand the pharmacologic treatment of Alzheimer’s disease.
  5. Differentiate mild cognitive impairment from Alzheimer’s disease.
  6. Apply principles of comprehensive care for dementia patients.
Date posted: 
Mon, 06/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
Dementia & Delirium TBL. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/85

Behavioral Approach to Agitation in 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 guidance for behavioral approaches for agitation in patients with dementia.  The target audience is Interdisciplinary Healthcare Professionals.  

Educational objectives: 

1) Define Dementia and discuss how it impacts communication and behavior

2) Define agitation and risks associated with pharmacological management of agitation in patients with dementia.

3) List non-pharmacological interventions for agitation.

Additional information/Special implementation requirements or guidelines: 

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

Date posted: 
Wed, 08/13/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/13/2014
Product Viewing Instructions: 
This video may take a few moments to load depending on your connection. Please wait if it does not appear right away.
Contact Person/Corresponding Author:



Suggested Citation:
Behavioral Approach to Agitation in Dementia. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/85

First Think Delirium! An effective way to teach residents and fellows about delirium

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

Three twenty-minute standardized patient encounters that are designed for learners of all levels and backgrounds to teach the Confusion Assessment Method and the diagnosis, evaluation, and management of delirium. Standardized cases include the following:

  • Older man with hypoactive delirium after taking Tylenol PM

  • Older woman with delirium in the setting of possible alcohol withdrawal

  • Older woman with terminal cancer presenting with delirium

Each case is designed to require the learner to interact with the patient's family member to obtain information about the acuity of the mental status change. There are no physical exams included but these could be added if desired. Feedback to the learners is provided by faculty facilitators who are geriatricians or specialty faculty who have been trained by geriatricians.

Submission includes standardized patient training materials, facilitator training materials, and PowerPoint materials for a didactic pre- and post-session. Finally, pre- and post-surveys to evaluate the learners and the workshop are included.

Educational objectives: 
  1. To evaluate all older adults for delirium using the Confusion Assessment Method Use.
  2. To interview an older adult's family member to obtain baseline health information, including activities of daily living and cognitive status.
  3. To manage delirium without using physical or chemical restraints.
  4. To consider alcohol withdrawal in an older adult presenting with altered mental status.
  5. To discuss goals of care with a patient's family member when the patient lacks capacity.
  6. To consider an adverse medication event as a cause of an older adult's altered mental status.
Additional information/Special implementation requirements or guidelines: 

This workshop may be modified for use by learners from different specialty backgrounds. At our institution, the workshop has been modified for Physical Medicine and Rehabilitation learners. In addition to changes in the patient conditions, patient presentation was changed to the Acute Inpatient Rehabilitation service or the Orthopedic Unit, two places were these learners see patients. The SP/CI pairs were re-trained prior to the workshop when changes were made. As a result, our SP/CI pairs received more training than the recommended two hours. We believe two hours is sufficient to train the SP/CI pairs as long as no changes are made between workshops. We highly recommend that the training sessions be led by a clinical content expert and an educator with experience in training standardized patients.

Finally, due to scheduling conflicts, we were unable to use the same actor pair for the same case with each workshop. Each case was portrayed by at least two actors, which highlighted the fact that some actors perform better than others. We highly recommend that the clinical content expert review the actors' portrayal of the cases before the workshop to ensure accuracy.

This workshop also requires training of faculty facilitators. Learners need feedback from faculty facilitators regarding their evaluation and management. Faculty facilitators must undergo a thorough, standardized training in order to function as effective teachers in this workshop setting. Our faculty facilitators, all of whom had already participated in a faculty development retreat on Geriatric Medicine topics, completed a 1 hour training session led by a geriatrician prior to the workshop. Again, we highly recommend that the facilitators undergo training led by a clinical content expert and receive additional information and training as needed depending on their clinical experience and background.

We recommend that the session occur in a clinical skills lab or an environment that simulates a clinical setting.

This entire workshop takes about 2 to 3 hours to complete when the full didactic session, pre- and post- tests, and program evaluation are included.

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

Wilson LA, Roberts E, Waller N, Biese K, Caprio A, Busby-Whitehead J.  “Three Standardized Patient Cases to Teach the Confusion Assessment Method to Diagnose Delirium."  MedEdPORTAL Publications.  Mar 2013.  Available from: www.mededportal.org/publication/9393.

Wilson LA, Roberts E, Hollar D, Waller N, Biese K, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.”  Journal of American Geriatrics Society.  2013, Volume 61, Issue Supplement s1, S43, Abstract A75.  Full text published first online on April 3, 2013.

Wilson LA, Roberts E, Caprio A, Winzelberg G, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.” Journal of American Geriatrics Society.  2012, Volume 60, Issue Supplement s4, S209-S210, Abstract D66.  Full text published first online on April 4, 2012.

Wilson LA, Waller N, Biese K, Roberts E, Busby-Whitehead J. “First Think Delirium!  An effective way to teach residents and fellows about delirium.” Annual Scientific Meeting, American Geriatrics Society, Grapevine, Texas.  May 4, 2013.  (Presentation, Invited). (1.5 hours, 50 attendees).

Wilson LA, Roberts E, Hollar D, Waller N, Biese K, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.”  Annual Scientific Meeting, American Geriatrics Society, Grapevine, Texas.  May 3, 2013. (Poster, Solicited).

Wilson LA, Roberts E, Hollar D, Waller N, Biese K, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.”, Council on Emergency Medicine Residency Directors Academic Assembly 2013. Denver, Colorado. March 7, 2013. (Poster, Solicited).

Wilson LA, Waller N, Adams S, Iwata I, Biese K, Vanderberg E.  “Using Standardized Patients and Collateral Informants in Geriatric Medicine Education.”  The Donald W. Reynolds Foundation 2012 Reynolds Grantee 19th Annual Meeting, St. Louis, Missouri.  October 22, 2012.  (Didactic Oral Presentation/Workshop, Solicited). (1 hour, 10 faculty members).

Wilson LA, Roberts E, Hollar D, Waller N, Biese K, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.” The John A. Hartford Foundation Interdisciplinary Scholars Communications Conference, Chicago, Illinois, July 10, 2012. (Poster, Solicited).

Wilson LA, Roberts E, Caprio A, Winzelberg G, Busby-Whitehead J. “An Innovative Approach to Teaching Delirium Using Standardized Patients.” Annual Scientific Meeting, American Geriatrics Society, Seattle, Washington, May 4, 2012. (Poster, Solicited).

Wilson LA, Caprio A, Roberts E“Training Subspecialty Faculty With Simulated Patients: Teaching General Skill Sets to Faculty.”  Gerolina, Kiawah Island, SC.  December 2, 2011. (Didactic Oral Presentation/Workshop, Solicited). (1 hour, 12 faculty members).

Date posted: 
Tue, 07/02/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 09/20/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . First Think Delirium! An effective way to teach residents and fellows about delirium. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/85

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/85

Psychosis, Agitation, and their Management with Psychotropic Medications in Older Adults

:  
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 describes use of psychotropic medications to manage psychosis and/or agitation in and elerly patient. The target audience is Interdisciplinary Healthcare Professionals.

Educational objectives: 

On completion, the learner will be able to:

  1. Define both Psychosis and Agitation
  2. Identify assessment tools to effectiviely diagnosis psychosis and agitation in an elderly patient
  3. List medications useful in the treatment of psychosis and/or agitation in the elderly patient
Additional information/Special implementation requirements or guidelines: 

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

The video may take a few moments to load based on your connection. Please wait a few minutes if it does not appear right away.

Date posted: 
Thu, 06/27/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/27/2013
Product Viewing Instructions: 
The video may take a moment to load based on your connection. Please wait a few minutes if it does not appear right away.
Contact Person/Corresponding Author:



Suggested Citation:
and . Psychosis, Agitation, and their Management with Psychotropic Medications in Older Adults. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/85

Pathophysiology and Treatment of 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 describes pathology and symptoms of dementia in the elderly. The target audience is Interdisciplinary Health Care Professionals.

Educational objectives: 
  1. Define pathology and symptoms of dementia in the elderly.
  2. Explain diagnosis of dementia and loss of memory in the elderly.
  3. List the behavioral and pharmacological treatments that are available for the elderly.
Additional information/Special implementation requirements or guidelines: 

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

The video may take a few moments to load based on your connection. Pleae wait if it does not appear right away.

Date posted: 
Mon, 06/03/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/03/2013
Contact Person/Corresponding Author:



Suggested Citation:
Pathophysiology and Treatment of Dementia. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/85

Caring Across the Continuum: Mrs. Porter Age 81

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

Caring Across the Continuum: An Aging Virtual Patient Series. Case Three: Mrs. Porter Age 81- Introduction to Common Geriatric Syndromes. This case, the third in a four-part series about the virtual patient, Mrs. Porter, introduces the learner to in-patient care, delirium and the interprofessional team (IPT) roles. The case is set in an Acute Care of the Elderly (ACE) Unit. Mrs. Porter is admitted to the ACE Unit with Dr. Pat and members of the IPT because she has had an unwitnessed fall and is delirious. Concepts included in this case are common etiologies and risk factors for falls; benefits of an IPT assessment in the ACE Unit; the effect of medication on falling; fall-induced delirium; types of delirium; the Confusion Assessment Method (CAM); obtaining a complete History of Present Illness; pain assessment; abnormal review of symptoms; and pre-operative testing.  After thorough evaluation, it is determined that Mrs. Porter has a fractured hip and will undergo surgery. The case concludes with a request of the learner to provide a complete pre-operative review of Mrs. Porter's assessment and exam.

Educational objectives: 

On completion of Case Three: Mrs. Porter Age 81, students will be able to:

  1. Define and describe select components of diagnosing an unwitnessed fall
  2. Describe multiple risk factors of falls
  3. Assess delirium using the Confusion Assessment Method (CAM) tool
  4. Provide a comprehensive abnormal review of symptoms for patient diagnosis
  5. Prepare a comprehensive pre-operative patient review
Additional information/Special implementation requirements or guidelines: 

This product is one part of a short series consisting of the following products:

As an innovative, virtual learning series, this web-based series of cases spans the 21-year relationship of care between geriatrician Dr. Patricia Thompson and her patient, Mrs. Alice Porter. This virtual learning experience for medical students, based on the Association of American Medical Colleges (AAMC) competencies, is designed to pique interest and enhance knowledge and skills in the care of older adults. The web-based learning environment provides students the unique opportunity to observe and interact with Mrs. Porter, in an ongoing doctor-patient relationship, outside of the traditional classroom setting. The series exposes students to the importance of continuity of patient care, since each case correlates to a different year of medical school education. As the medical student advances in their curriculum, Mrs. Porter continues to age, requiring more complex care and further application of critical thinking skills from the student. Each case has a unique focus that targets key geriatric and/or palliative concepts appropriate to the level of the student that can easily be embedded into existing medical school courses.

The virtual cases allow students to explore approaches to the patient; observe model clinician-patient interactions; choose practice techniques; offer health promotion, palliative counseling, and patient counseling; and contemplate complex ethical decisions regarding the care of the patient in an innocuous, self-paced, virtual environment. The embedded natural language system in each case offers an opportunity to pose real-world questions and problems to the learner, with the goal of eliciting critical thinking skills and reflective learning.

The series offers a readily available complementary assignment to the classroom and clinical experience. The self-paced case studies contain video animation, an interactive electronic medical record, Geriatric Gems and Palliative Pearls, natural language style critical thinking, clinical reasoning and clinical judgment learning activities, and evidence-based expert explanations. Evaluative tools include a pre and post quiz and rubric-scored natural language short answer and essay questions. The natural language system provides hints to the students and evaluates their responses based on the information they provide. Student actions and choices are captured for formative evaluation, as well as to provide student feedback.

The virtual patient system is a web-based application that runs on Windows Server, running IIS with ASP enabled within IIS. The project database is Microsoft Access.

The first time you explore a case, you will need to register. There is a "Register" button at the bottom of the login form. Click this button to register or to have your password sent to the email address you entered when you registered.

On the popup registration form, you will need to enter an ID and a password. Your ID can be anything you wish. You can use the same User ID and password for any of the four cases. All of the other fields are optional. (The email field is optional. If you don't enter an email address when you register, the system can't send you your password and/or ID if you forget them.)

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

Using a Virtual Patient to Teach the Comprehensive Geriatric Assessment to Medical Students. Poster presented February 24, 2012 at the AGHE Annual Meeting and Educational Leadership Conference.

Instructional Design and Management of a Virtual World: A Second Life for Geriatric Education. Project Demonstration presented February 3, 2011 at The University of Texas Academy of Health Science Education Interprofessional Health Science Education Conference.

Instructional Design and Management in a Virtual Environment: A Second Life for Geriatric Education. Presented October 25, 2010 at the Ninth Annual Reynolds Grantee Meeting.

Date posted: 
Fri, 02/15/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 02/15/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , and . Caring Across the Continuum: Mrs. Porter Age 81. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/85

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