INTERNAL MEDICINE (GERIATRICS)

INTERNAL MEDICINE (GERIATRICS)

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iten
Code
80800
ACADEMIC YEAR
2016/2017
CREDITS
2 credits during the 6th year of 8745 MEDICINE AND SURGERY (LM-41) GENOVA
SCIENTIFIC DISCIPLINARY SECTOR
MED/09
LANGUAGE
Italiano
TEACHING LOCATION
GENOVA (MEDICINE AND SURGERY)
semester
1° Semester
modules
This unit is a module of:

OVERVIEW

Old patient has a different physiology and more complicated pathology in comparison to the adults, and he needs a targeted approach. The multi-dimensional and customized analysis of aged person has to be learned according to information derived from practical clinical experience, mainly in the ward. In an aging world, it is essential to have some experience in the geriatric area, whatever the field you will work after graduation.

AIMS AND CONTENT

LEARNING OUTCOMES

The student must be able:
-to understand the European and Italian epidemiology, in particular the population demographic changes
-to recognize the changes that the older person shows and  know how to approach him/her clinically, psychologically and with humanity
-to apply the international multidimensional evaluation methods (i.e. the “comprehensive geriatric assessment”)
- learn about the various degrees of fragility, complexity and the elderly person's severe impairment
- to know and be able to diagnose and treat the most common diseases of elderly (geriatric syndromes)
- Set an effective analgesic therapy after a precise evaluation of pain

- to implement the pathologic aging prevention, plan a healthy life, to know and apply a judicious and wise anti-aging therapy
- to address the ethical and deontological problems in the elderly population, the undue treatment and palliation
- to properly use the network of services for the elderly

 

LEARNING OUTCOMES (FURTHER INFO)

 

The student once acquired the core curriculum of geriatrics will be able to:

evaluate the impact of age-related changes on the physiology, comorbidity and drug selection and prescription

know the drugs that should be prescribed with caution or avoided

to have full knowledge of the possible adverse events, food, diseases and molecules interactions with the drugs used in the elderly

differentiate the clinical presentation of delirium, dementia and depression

formulate a differential diagnosis and observe the clinical relevance of a patient with cognitive impairment; set the specific drug therapy and non-pharmacological

assess the cognitive abilities of an elderly with memory problems

establish the functional capacity of an elderly, including sensory conditions; perform a physical examination focused on elderly


develop a plan to manage frailty and disability through environmental adaptation and social interventions; participate to a multidisciplinary team (UVG)

identify safety risks to the patient's home and recommend appropriate changes

analyze the falls, assess the gait and postural stability, interpret tests and set up a prevention and treatment plan

check the family, social, environmental situation and the organization of life of the elderly

assessing the life expectancy, the clinical condition, the patient's preferences, realistic goals for the a diagnostic screening and for a cure

to know the the possibility of atypical presentations, orphan symptoms, shared symptoms of different diseases

knowing how to assess pain even in the patient with dementia, how to set up a therapy and re-check it over time

learn about palliative care and hospice care as a positive option for the patient

know the risks of hospitalization, risk prevention and find a possible treatment

know what are the limits and the risks of physical and pharmacological restraints


set a discharge from a hospital or nursing home, with the review of medications, the follow-up, the signs of rehabilitation and the address correctly the patient and his family in the network of services

know how to prevent and deal effectively with the pressure sores

address the ethical and clinical problems in the last part of the patient's life

Teaching methods

Plenary Lectures (10 hours and minimum 30 hours of clinical activities in the ward)
Professional training in the ward for acute cases, in the intermediate care and with the outpatient care
Students are invited to participate to the weekly departmental meetings on complex clinical cases and upgrading seminars.

 

SYLLABUS/CONTENT

Keep in mind the demographic aspects of aging in Italy and in the EU, emphasizing the clinical implications for the area of internal medicine and for the primary care
Know how to utilize, according to the international guidelines, the specific tools for clinical approach (history and physical examination) of elderly patients
Describe the distinctive aspects and the atypical presentation of geriatric pathologies

Address the diagnostic, prognostic, therapeutic and rehabilitative peculiar features of oldest pathologic conditions and face the comorbidity, the "Geriatric syndromes", as well the "orphan" symptoms
Define the concept of life expectancy in comparison to the common conditions in the elderly: polypathology, disability and frailty.
Discuss the relationship between quality and “quantity” of life in the old, the respect and the value of senility and identify how aggressive can be a therapy
Explain and critically discuss the principles and
methodology of multidimensional geriatric assessment and prognostic indexes especially in relation to
concept of "fragility" of complexity and clinical severity.
Define the utility and the methods of access to geriatric care network depending on patient characteristics and local experiences
Describe the lifestyles and practical approach to healthy aging; how to implement a preventive strategy and critically weighed anti-aging therapy
Knowing the problems of mistreatment and abuses on the weak and frail old person, including restraints

How to use the informed consent and the support services for the elderly.

 

RECOMMENDED READING/BIBLIOGRAPHY

Hazzard's Geriatric Medicine and Gerontology, Mc Graw-Hill 2017

Ham – Primary care geriatrics – Saunders 2014

Oxford’s handbook of geriatric medicine – Oxford 2012

TEACHERS AND EXAM BOARD

Ricevimento: every monday after lessons ( from 16.30-17.30) and on student's request by sending email ( fiammetta.monacelli@unige.it) for a scheduled appointment

Ricevimento: The student reception is booked by mail (Professors address at UNIGE website): the answer is usually within 48 hours.  

Exam Board

ALBERTO BALLESTRERO (President)

FRANCO DALLEGRI (President)

GIUSEPPE NOBERASCO

ANDREA STIMAMIGLIO

PATRIZIO ODETTI

FRANCO PATRONE

LIVIA PISCIOTTA

GIOVANNI MURIALDO

MARIO SESSAREGO

FIAMMETTA MONACELLI

STEFANO BERTOLINI

EMILIA BELLONE

ANGELO GIULIANO CATALDI

FABIO FERRANDO

RICCARDO GHIO

FABRIZIO MONTECUCCO

PAOLA MANDICH

FRANCESCO PUPPO

LESSONS

Teaching methods

Plenary Lectures (10 hours and minimum 30 hours of clinical activities in the ward)
Professional training in the ward for acute cases, in the intermediate care and with the outpatient care
Students are invited to participate to the weekly departmental meetings on complex clinical cases and upgrading seminars.

 

EXAMS

Exam description

A written / computerized preliminary test is based on n. 30 multiple choice questions on topics of Medicine and n. 30 multiple choice questions on Geriatrics.
The written test of Medical Genetics consists in two cases of consultancy, different for each student and a short answer on the field is due.
For each correct answer you will be awarded one point, zero points for each question not answered or wrong.
For passing each test at least a 18/30 score has to be attained.
The test is valid for the oral exam only for the session in which it was done.
Final oral examination: a compilation of a medical records relating to a clinical case at the bedside with discussion.

 

Assessment methods

The test is done by a series of multiple-choice questions that are useful to check the effective acquisition by the student of essential information for the expected learning target about the integrated course.
A score not lower than 18/30 it allows the student to pass the preliminary test.
The second part of the exam is designed to assess the student's know-how in the area of ​​the course and it contributes to the final score (max. 30):
The ability to review in a critical way and treat the required arguments also from the practical point of view is appreciated; the accuracy, the clarity, the synthesis and speech fluidity are quality also esteemed; the skills for the approach to the patient, the respect, humanity and ability to ask questions and get appropriate answers will be evaluated
Mastery of the knowledge and expertise in the personalization of medicine are considered priority, as the adoption of appropriate terminology, not overly technical, in the approach to the patient
The score of 30/30 cum laude, it will be granted when the knowledge / skills of the field are outstanding.

FURTHER INFORMATION

Three complementary teaching activities (ADE) are available for students:
The first concerns the approach to acute geriatric patient (at the Geriatric Clinic); the second is an experience in the outpatient clinic (memory clinic and oncogeriatrics); the third is the frequency in the intermediate care ward, spool between the acute care and the home or residential care.

The thesis can be obtained from one of the teachers of Geriatrics and the list of themes will be available at the DiMI Student’s Office .

The educational material will be available on the DiMI website.