Knowledge guide

Knowledge guide 1: 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