AMBULATORY GERIATRIC EXPERIENCE (AGE)

Director: Jamehl L. Demons, M.D.

 

Overview:

The interns (H01) of the Internal Medicine Residency of North Carolina Baptist Hospital spend one month on the Ambulatory Geriatric Experience (AGE). With the graying of America, the elderly population is an escapable facet of adult medical practice.  A well-trained internist will need to not only recognize the aging process, but recognize the difference between natural aging and intervening medical issues that lead to impaired aging. 

 

While there are over 50 million people in the United States who are over the age of 65, right here in North Carolina, the over 65 population has increased by 20% in the last 10 years and is expected to more than double by 2030.  The elderly population however is a heterogeneous group and live in a variety of settings each with its own unique staffing, physician requirements and focus.

 

Over the course of a month in the AGE rotation, the intern will be exposed to these multiple levels of care with the overall goal of understanding the continuum of care and their integration with each other particularly as the interns continue to gain expertise during the remainder of their residency program in a hospital based setting.

 

Principle Teaching/Learning Activities:

 

 

Aging Conference (AC):  The aging conference occurs biweekly on Wednesday afternoon from 1:30 p.m.-2:30 p.m. from September through the first week of June.  In this conference, both research and clinical topics in Geriatric Medicine are covered. 

 

Ambulatory Care Clinic (ACC) - Under the direction of a geriatrics attending, the intern will interview and examine ambulatory elderly patients.  They will make medical management recommendations to the attending physician.  Specific characteristics of the aged patient are elucidated by the attending physician along with additional review of historical or physical exam findings.

 

ACE Transition Program (ATP) - Under the direction of the Acute Care of the Elderly (ACE) unit fellow, the intern will make a single investigative visit to patients who have been discharged from the ACE unit into the Winston-Salem community.  Over the course of the month, the intern is to follow patients into several different settings including home, subacute rehabilitation, acute rehabilitation, assisted living and traditional long-term care.  A formal written note is required and a presentation is given to the ACE unit multi-disciplinary team including medical and ancillary staff weekly.  This will serve also to inform the ACE unit team of the outcome of patients following discharge and instruct on methods of improving the transition from the ACE unit to any one of these diverse settings.

 

Geriatric Consultation Clinic (GCC) - Monthly, the GCC is held in the geriatric outpatient clinic area.  This is a consultative clinic which focuses on the evaluation of geriatric syndromes.  The intern as a member of the team will see patients and help to formulate an assessment and plan of action.  The attention is particularly paid to dementia as an intercurrent problem, urinary incontinence, functional impairment, falls, gait instability, family and social concerns and an understanding of the health care system for the elderly will be learned from this experience.

 

Memory Assessment Clinic (MAC) - The first three Mondays each month from 1 p.m. until 5 p.m. the Memory Assessment Clinic (MAC) is held in the geriatric outpatient clinic area.  These are conducted by an attending physician and geriatrics fellows.  This clinic focuses on detailed evaluations of mild to moderate cognitive impairment.  The intern will interview patients and available family members regarding the cognitive history, as well as, focusing on other geriatric syndromes that may impair the cognition including depression, polypharmacy sensory impairment, etc.  The intern will have the opportunity to work with trained interdisciplinary clinical research staff from the Kulynych Center for Memory and Cognition Research, as well as, pharmacy and legal consultants.  

 

Geriatric Journal Club (GJC): Geriatrics Journal Club occurs biweekly on Wednesday afternoon from 1:30-2:30 p.m. between September and June.  The purpose of this conference is to provide a review of new research in Geriatric Medicine, and to learn critical appraisal and research methodology skills. 

 

Internal Medicine Grand Rounds (GR):  Are scheduled every Thursday 8:00 a.m.-9:00 a.m. from September through the first week of June. 

 

House Calls (HC) - The Sticht Center Physician House Call Program is an interdisciplinary home care program which integrates medical and social support services in the care of chronically and disabled older persons.  One to two afternoons per week, the AGE intern will accompany the geriatrics fellow to a participant's home to evaluate chronic or acute medical conditions.  They will discuss with the fellow and the family any additional caregiving or social service assistance needed and help to arrange services as appropriate.

 

Internal Medicine Noon conferences (NC):  The intern on the AGE rotation is expected to attend a minimum of 60% of noon conferences. 

 

Nursing Home (BR) - Two to three half days per week, the AGE intern will work with the Geriatrics fellow to complete histories, physicals and medical management of nursing home and assisted living residents at the Brookridge Retirement Community.  Brookridge is a continuing care retirement community (CCRC) which includes all levels of care including independent, assisted living, long term care and rehabilitative/subacute care.   The intern will be exposed to all of these levels of care along with didactics from the geriatric attending regarding regulations, physician responsibilities and specific emphasis on common geriatric syndromes.  The intern will come to understand the patient profile associated with each level of care and financial implications associated with each level of care.

 

 

Principle Educational Goals by Relevant Competency

 

In the table below, the principal educational goals for AGE and the relevant principal teaching/learning activity is indicated by each goal using the legend below.

 

*Legend for Learning Activities        

AC - Aging Conference

GCC - Geriatric Consultation Clinic

HC - House Calls

ACC - Ambulatory Care Clinic

GJC – Geriatric Journal Club

MAC - Memory Assessment Clinic               

ATP - ACE Transitional Program

GR - Grand Rounds

NC - Noon conferences

BR - Nursing Home (Brookridge)