Core Adult Internal Medicine Disciplines

Geriatric Medicine

Topics

• Normal physiological ageing: the effects of ageing on organ systems and reduced functional reserve.
  
• Alteration of normal physical examination with ageing.
  
• Interpretation of laboratory values in older people.
  
• Knowledge of the nonspecific and differing presentation of disease in elderly people.
  
• Management of the special syndromes encountered in old age: falls, cognitive impairment, delirium, pain, urinary and faecal incontinence, constipation, gait disorders.
  
• Management of specific diseases with strong age associated risk such as stroke disease, hypertension and hypotension, dementia, arthritis, osteoporosis, pressure ulcers, Parkinson's disease.
  
• The hazards of drug treatment in elderly people: pharmacokinetic and pharmacodynamic changes in drug handling with age and disease; the risks of multiple drug prescription; iatrogenic drug-induced diseases; compliance in the elderly.
  
• The presentation and management of psychiatric illness in old age and its relationship to physical illness.
  
• The importance of the functional assessment of elderly patients in terms of impairment, disability and handicap that also includes social, psychological and environmental dimensions.
  
• Skill in managing elderly people with complex multiple disabilities.
  
• An understanding of some of the physical, psychological and social changes that occur with age and attitudes of society towards ageing, and the importance in the face of illness and frailty of promoting older peoples' dignity and sense of identity.
  
• The use of rating scales in particular clinical situations, for example a mental test score such as the Folstein MMSE, a geriatric depression scale and scoring of activities of daily living using a recognised scale.
  
• Understanding of important ethical and legal issues in caring for elderly people.
  
• Understanding the role of aids (including hearing aids) and appliances in the rehabilitation of elderly disabled people.
  
• Knowledge and skill in assessing competency required for decision making and providing informed consent and knowledge of the legal standing of alternative decision makers.
  
• Understanding of the medical role in a multidisciplinary team and understanding the role of each discipline in care of the elderly.
  
• Knowledge of the community services available to support older people at home.
  
• Importance of health education and health promotion for elderly people.
  
• Knowledge of residential care facilities.

Practical Skills for all Trainees

Administration of functional and cognitive assessment scales.

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