Here - American Geriatrics Society

P OSTER
A BSTRACTS
of the education intervention. In WI, team members made changes in
their practice by convening with the team, discussing options, and
slowing down. The main barrier to implementation of the project is
not enough support, time constraints, and staff absences. In 2012,
RITT will be implemented at 10 additional sites with more clinical
geriatric teaching content. In conclusion, RITT led to team-based
practice changes in rural clinics and reinforced the other educational
activities of the Geriatric Scholars Program. It also had a “spill over”
effect by taking team training “on the road” to rural clinics where the
Scholars’ colleagues did not have the opportunity to participate.
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G-FACTS - Point of Care Geriatric Resources with a Basic
Science Twist.
E. H. Duthie, 1 J. Rehm, 2 K. Denson, 1 S. Denson, 1 B. Wessel, 1
D. Brown, 2 D. Simpson, 2 G. Colloborrative. 2 1. Medicine, Medical
College of Wisconsin, Milwaukee, WI; 2. Academic Affairs
Educational Services, Medical College of Wisconsin, Milwaukee, WI.
Supported By: Reynolds Foundation; Health Services Resources
Administration Geriatric Education Center; Department of
Veterans Affairs; MCW Injury Research Center
Introduction:
Geriatrics related clinical training of residents and fellows continues
to be in the crosshairs of competing forces ranging from new
duty hour limitations and required ACGME/RRC topics to escalating
clinical productivity expectations for teachers. Trainees now expect
immediate access to point of care clinical resources to inform assessment,
diagnosis and management decisions. Currently an array of
e-based clinical resources are available but these resources often omit
the underlying basic sciences to inform action and are highly variable
in quality, level of evidence-based guidance and technology accessibility
(e.g., instant search, access, down load ).
Methods:
Since 2000, Medical College of Wisconsin has successfully provided
just-in time, point-of-care instruction through its End of
Life/Palliative Care Resource Center (EPERC) Fast Fasts. These
concise, practical, peer-reviewed, and evidence-based summaries on
key topics have demonstrated an increase in intern medical knowledge
and self-reported preparedness in symptom management skills.
Adopting this model for geriatrics a blueprint of relevant topics was
identified by a multi-specialty work group and agreement regarding
format/layout to meet our criterion for point of care actional intelligence
emerging from the sciences underlying medicine. Authored by
multi-specialty team including medical students, residents, fellows
and faculty, the fast facts cross specialties.
Results:
An interactive, searchable website houses the geriatric fast facts
(Geriatrics Fast Facts) indexed by common geriatrics topics, ACGME
competencies, organ system, and diseases. Fast facts are keyed as assessment,
etiology, diagnosis, and/or management focused. Download
time is seamless as file sizes and layout adapt to web or mobile devices.
Examples of Geriatrics Fast Facts include rib fractures, pharmacologic
aspects of drug clearance in elderly patient with reduced function,
gait and balance assessment, and hypertension with positive
reviews from faculty and residents alike.
Discussion:
Geriatrics Fast Facts address the“mobile access now”point-of-care
needs of trainees and faculty alike.The incorporation of the sciences underlying
geriatrics provides a unique and added value for residency/fellowship
programs seeking to fulfill ACGME RRC requirements.
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Confusion about Delirium.
J. Defillo Draiby, M. Drickamer. Geriatrics, Yale School of Medicine,
New Haven, CT.
Delirium is an important clinical syndrome in the elderly and
is related to increased mortality and hospital length of stay, long
term functional and cognitive decline and institutionalization. Despite
being responsible for higher mortality rates than sepsis or
myocardial infarction, delirium is often not diagnosed or improperly
addressed. We evaluated resident’s level of knowledge and
confidence in regards to delirium in order to inform future formative
interventions.
Methods: A web-based questionnaire was given to third year
medical residents. Chief Residents emailed all residents with information
on the nature of the survey with a brief explanation of the importance
of delirium. The 15 questions were designed to elicit basic
knowledge in diagnosis, predisposing and precipitating factors; prevalence,
prevention, management, attitudes and beliefs. The responses
were tabulated in tables and interpreted by consensus.
Results: 30 0f 45 residents completed the survey. 72 % had never
used a delirium assessment tool. 50 % did not feel they have a good
working knowledge of the diagnosis of delirium. 49% thought they
did not have adequate training in delirium with only 33% feeling
comfortable managing it. Half thought delirium is under-recognized
in the emergency department. 77% of resident thought that staffing
constraints augment the need for restraints. 1/3 of our participants
would use a high dose haloperidol or benzodiazepine to control hyperactive
delirium. Delirium features was described as altered level
of consciousness and fluctuating in 67% of the respondent. The predisposing
factors most frequently recognized were age (27%) and
baseline cognitive status (27%). Of precipitating factors, acute illness
was the most recognized (77%) followed by medications (67%) and
environment (60%).
Conclusion: The study illustrates the deficits of third year medical
residents in regards to delirium. They expressed concern about
the adequacy of their baseline knowledge and most were unaware of
any validated instrument to diagnose delirium. Half felt that they did
not have enough training in delirium and only 1/3 of the residents felt
confident in managing delirium. This lack of confidence is accompanied
by lack of awareness of predisposing and precipitating factors of
delirium all of which impact the care of the hospitalized elderly. The
study is important in creating future educational interventions to solidify
Geriatric teaching in our institution.
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Living the Life of an Older Adult Resident in a Nursing Home:
Applying Learning by Living© Methods.
K. F. Janes, 1 M. R. Gugliucci. 2 1. School of Social Work, University of
Maine, Orono, ME; 2. College of Osteopathic Medicine, University of
New England, Biddeford, ME.
Supported By: Lakewood Continue Care Center
University of New England College of Osteopathic Medicine
Background: Only three percent of social work students choose
a career in the aging field and yet between 8,000 and 10,000 people
are turning 65/day. There is a critical need for social workers to be
trained in gerontology. This study determined if Learning by Living©
research protocols could be applied to enhance learning for an MSW
student about aging.
Methods: A qualitative ethnographic/biographic research design
was applied, whereby a social work student volunteered to live as an
elder resident in a nursing home for 12 days, 24/7, complete with medical
diagnoses and “standard” procedures of care (toileting, transferring,
bathing, feeding, etc). Qualitative data (field notes) included
subjective and objective reporting of observations and experiences.
Field notes were analyzed applying content analysis, thematic categorization
and coding using manual analysis methods, and QSR N-Vivo
Research Software.
Results: Data stages included: Pre-admission; daily life; the
“Ahaa” moment; and discharge. Themes included: Frustration, de-
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AGS 2012 ANNUAL MEETING