Adult Internal Medicine: Geriatric Medicine

Presentations

• Constipation
• Deconditioning following illness
• Dementia, behavioural and psychological symptoms
• Falls
• Fractures
• Functional decline
• Gait abnormalities or gait disorders
• Incontinence, faecal and urinary
• Psychiatric presentations, such as anxiety, depression, mania, and psychosis

Conditions

• Arthritis:
  • acute monoarthritis
  • crystal associated arthritis, including gout and pseudogout
  • osteoarthritis, generalised and regional
  • polymyalgia rheumatica
  • septic arthritis
• Cardiac conditions:
  • atrial fibrillation
  • heart failure
  • ischaemic heart disease
• Delirium
• Dementia syndromes, such as:
  • Alzheimer disease
  • dementia with Lewy bodies
  • frontotemporal dementia
  • vascular dementia
• Elder abuse or family violence
• Herpes zoster
• Malnutrition and weight loss
• Oncological conditions
• Orthostatic hypotension
• Osteoporosis
• Respiratory conditions:
  • chronic obstructive pulmonary disease
  • pneumonia or aspiration pneumonia
• Ulcers:
  • arterial
  • neuropathic
  • pressure sores
  • shingles
  • traumatic
  • venous
• Urinary tract infections
• Stroke

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

Presentations

• Frailty

Conditions

• Substance use disorders:
  • overdose
  • withdrawal

For each presentation and condition, Basic Trainees will know how to:

Synthesise

• recognise the clinical presentation
• identify relevant epidemiology, pathophysiology, and clinical science
• take a relevant clinical history
• conduct an appropriate examination
• establish a differential diagnosis
• plan and arrange appropriate investigations
• consider the impact of illness and disease on patients¹ and their quality of life

Manage

• provide evidence-based management
  For less common or more complex presentations and conditions the trainee must also seek expert opinions
• prescribe therapies tailored to patients’ needs and conditions
• recognise potential complications of disease and its management, and initiate preventative strategies
• involve multidisciplinary teams

Consider other factors

• identify individual and social factors and the impact of these on diagnosis and management

• Biology of ageing
• Changes associated with ageing in major organ systems
• Concepts to be considered when appraising applicability of evidence to older people:
  • adverse event reporting
  • generalisability
  • levels of evidence
  • number needed to harm
  • number needed to treat
  • sub-group analyses
• Pathophysiology of dementia
• Pharmacological changes in ageing patients

Investigations

• Basic imaging, including but not limited to:
  • CT or MRI brain imaging
  • DXA bone scan reports
• Cerebrospinal fluid (CSF), particularly in the context of delirium or acute confusional state
• Laboratory tests, including but not limited to assessment of renal function in older patients

Clinical assessment tools

• Assessment of capacity to give informed consent
• Screening tools for depression in older patients
• Tests of attention in context of delirium
• Tests of cognitive function, including delirium

• Clinical issues:
  • appropriateness of or need for residential care
  • discharge planning in older people
  • distinction between urinary tract infections and asymptomatic bacteriuria
  • functional decline, frailty, and multimorbidity, and their implication for management
  • judicious use of investigations and treatments in context of ageing, and recognition of situations where further investigation and management may not be of benefit or could be harmful
  • non-specific presentations of disease in older patients
  • non-surgical management of fractures in patients with osteoporosis
  • pain management in older patients, especially in the context of renal impairment
  • perioperative assessment and care
  • polypharmacy and prescribing issues in older patients, such as adverse drug reactions
  • prevention and management of complications associated with acute illness and immobilisation
  • setting appropriate treatment or rehabilitation goals for individual patients
• Ethical and legal issues:
  • ethics of managing older patients:
    • advocacy
    • beneficence versus non-maleficence
  • medicolegal considerations and legal framework regarding care of the older person, such as:
    • advance care directives
    • competency and decision-making capacity
    • duty of care
    • end-of-life decision making
    • guardianship, power of attorney, and proxy decision makers
    • medical futility
    • resuscitation
• Patient-centred care and multidisciplinary issues:
  • assessment of older patients with English as a second language
  • collaboration with general practitioners, allied health, and other medical specialists to achieve the best outcomes for patients
  • person- or patient-centred care as a concept, such as actively including patients, families, and carers in decisions regarding the health care or rehabilitation process
  • potential disadvantages arising from disability or ageing and how to assist persons in achieving their full rights in society
  • psychosocial factors that may influence health and rehabilitation
  • role of multidisciplinary team members in diagnosis and management
  • services available to support older people and their carers in the community