Geriatric medicine curriculum standards

Knowledge guide

LG 17: Clinical and social sciences

Epidemiology, Pathophysiology, and Clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.

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Ageing of body systems - physiological ageing of body systems including vision, hearing, and balance
Cellular senescence and physiology of ageing, including physiological aspects that do not change as a result of ageing
Definitions and characteristics of frailty, resilience, intrinsic capacity, and sarcopenia
Demographics of ageing
Determinants of successful ageing, e.g. lifestyle choices that impact, including a low-calorie diet, exercise, alcohol use, and smoking
Differentiate between biological, chronological, and the perceptions of ageing
How ageing affects the response to specific homeostatic challenges
- altered physical activity
- changes to ambient temperature
- fluid challenges and dehydration
Impaired immunity
Lab test interpretation, including the alteration of the normal range and biomarkers in ageing
Loss of homeostasis and physiologic reserve
Psychology of ageing
The life expectancy for different age groups
Theories of normal ageing, biological ageing, theories of the mechanisms (environment), and genetic changes of ageing
The proportion of older people living in different types of residential care
Use knowledge of normal and abnormal ageing in clinical assessment and management

Examinations

Performing and interpretation of below investigations:

Chest and back
Cognition and mental health
Comprehensive geriatric assessment
Coordination
Dynamometer and handgrip strength
Gait and posture
Gastrointestinal system
Head and neck and neurological assessment
Medication review
Muscle strength
Nutritional assessment
Pelvic examination
Prostate examination
Reflexes
Routine haematology
Sensation
Skin
Socioenvironmental circumstances

Investigations

Performing and interpretation of below investigations:

Anatomical imaging - CT, MRI, x-ray
Functional imaging - PET
Routine biochemistry
Routine haematology
Ultrasound, e.g. bladder scan
Urine tests

Standardised clinical assessment tools

Refer to the relevant knowledge guide for specific tools to assess cognition and mental state (KG 2), and frailty and functional decline (KG 4)

Family and personal life

Carer burn out and stress
Change in independence level
Change role in families and contribution to care, including grandparenting and spouse
Elder abuse
Grief and bereavement
Social and relationship changes, and sexuality
The social issues of ageing, including cultural differences

Mental health and wellbeing

Depression and anxiety
Self-esteem and self-worth
Sexual function and sexuality
The most common medical conditions prevalent in older people, and the conditions responsible for most disabilities
The prevalence of activities of daily living (ADL) and instrumental activities of daily living (iADL) disability in community-living older people, and the risk factors for functional decline

Social and economic factors

Ageing versus disease, e.g. how health conditions can be attributed to age and/or disease
Attitudes of older people to health, quality of life, and social relationships
Attitudes to ageing and stereotypes in society
Coordinating and accessing transportation, services, and leisure activities
Driving
Formal and informal community services by older people
Retirement and financial security
The range of weekly income of older people in the community and state, and the average pension income
Transitions to supported accommodation, e.g. community care and residential care

Positive aspects of ageing

Wisdom, self-satisfaction, crystalline memory
Value of a life lived
Value of experiences
Value of older people in society

Pharmacology

Adverse effects due to medications
Age and disease related changes in pharmacokinetics and pharmacodynamics when prescribing
Altered drug handling
Changes in pharmacodynamics with normal ageing
Communicate with patients and their doctors regarding rationale for prescribing
Compliance issues in older people
Limitations of evidence for drug use in older people
Polypharmacy - appropriate and inappropriate
Prevalence and spectrum of adverse drug reactions - prescribing cascades
Review and modify patients’ prescription, non-prescription and complementary medications
Strategies that can improve prescribing in older people, such as regular medication review, and ‘start low and go slow’
Tailor interventions and treatment, taking into account frailty, reduced homeostasis, impaired immunity, and reduced reserve
The evidence for medication deprescribing and adherence, including psychotropic medications
The important of collaboration and communication with pharmacists
The risk-benefit balance when prescribing for older people
The significance of and reasons for polypharmacy