Family Medicine Clerkship

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Frailty

OVERVIEW

The number of patients over 65 is growing, but the proportion of patients over 85 is growing exponentially. Although most elderly patients will enjoy good health, an increasing number of the very elderly will experience the consequences of multiple chronic diseases that will impair their ability to function. This group is sometimes referred to as the frail elderly and represents a particular challenge to the health care provider. Not only are these patients frequently on multiple medications, but also their impaired ability to care for themselves makes them more susceptible to falls, social isolation, malnutrition and other conditions. In addition, their special needs place an additional burden on families and caregivers. Family physicians must become adept at managing the multiple medical and social concerns of the frail elderly.

TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess a frail elderly patient.

OBJECTIVES: Students will be able to:

• Perform a comprehensive history and physical assessment of a frail elderly patient.
• Perform at least two commonly used tests to determine the functional ability of an elderly patient, e.g., the "get up and go" test, and the Mini-Mental Status Examination.

GOAL: Students will appropriately discuss medical and social issues with frail patients and their families.

OBJECTIVES: Students will be able to:

• Describe to patients and their families/caregivers the risks associated with their frail state (e.g., fall risk).

GOAL: Students will be sensitive to individual and cultural differences in the development of treatment plans for frail elderly patients.

OBJECTIVES: Students will be able to:

• Convey to patients and family the importance of environment in reducing risk and improving quality of life for the frail elderly patient.
• Develop treatment plans in the context of each patient's life and environment that reflect input from family and caregivers.

Medical Knowledge

GOAL: Students will understand the medical, psychological, and social needs of the frail elderly patient.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of aging.
• Describe the USPSTF recommendations for screening for elderly patients.

GOAL: Students will know the most common medical, psychological, and social conditions of the frail elderly.

OBJECTIVES: Students will be able to:

• Describe the impact of complications of multiple chronic diseases on the functional ability of the frail elderly patient.
• Describe the role of family and caregivers in the care of the frail elderly patient.

GOAL: Students will understand the rationale for the management of the frail elderly patient.

OBJECTIVES: Students will be able to:

• Describe appropriate therapies for the frail elderly including the role of PT/OT, nursing, home care, hospice.
• Discuss the need for environmental modifications to reduce fall risk and enhance function.
• Discuss the side effects and costs of commonly used medications, including the impact of polypharmacy.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of the family physician in caring for the frail elderly patient in practice and community settings (e.g., home care, nursing home, or assisted living).

OBJECTIVES: Students will be able to:

• Perform a home assessment of an elderly patient.
• Conduct a nursing home visit on a frail elderly patient.
• Describe the role of the practice in providing care to the frail elderly patient across multiple settings.

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to the care of the frail elderly patient.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with frail elderly patients and their families/caregivers.

OBJECTIVES: Students will be able to:

• Describe the long-term treatment plans for a frail elderly patient, including the integration of available social services for elderly patients.
• Include patients and families in the development of treatment plans.
• Demonstrate effective listening skills and empathy to family members and caregivers who are involved in the care of a frail elderly patient.

Professionalism

GOAL: Students will demonstrate the ability to care for frail elderly patients from diverse patient backgrounds and in different settings.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with frail elderly patients and their families/caregivers who are not adhering to treatment plans.
• Reflect on personal frustrations and transform this response into a deeper understanding when patients are not adherent to plans.
• Demonstrate understanding of the role of caregiver in relationship to culture, age, gender, and disabilities.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of frail elderly patients.

OBJECTIVES: Students will be able to:

• Access community-based services available in the practice community to assist in the care of the frail elderly patient.
• Analyze barriers to effective integrated care of the frail elderly patient (including financial and political barriers).
• Consider the role of other disciplines, [e.g., nursing, social work, PT/OT and community agencies] in the care of the frail elderly patient.

EDUCATIONAL METHODS AND RESOURCES

Clinical Experience

• Home Visit
  
• Nursing Home Visit
  
• Visit to Adult Day Care

Other

• STFM Group On Geriatric Education - Christine Arenson, MD

Lead Author: Janice Nevin, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004