Description

Medical students completing the geriatric rotation at MSK will be able to perform geriatric assessment using various tools to identify geriatric syndromes in elderly cancer patients and formulate a preliminary management plan.

Cognitive and behavioral disorders: Compare and contrast among the clinical presentations of delirium, dementia, and depression and be able to formulate differential diagnosis in patients presenting with these problems using assessment tools such as MiniCog, CAM or GDS; and determine the root cause and be able to develop a non-pharmacologic management plan for agitated demented or delirious patients.

Medication management: Explain the impact of age-related physiologic changes on drug selection and dose, identify medications (including prescribed, herbal and over-the-counter medications) which should be avoided or used with caution in older cancer patients while assessing for side effects and adherence.

Suggested Literature

Steinman, M.A. and J.T. Hanlon, Managing medications in clinically complex elders: “There’s got to be a happy medium”. JAMA, 2010. 304(14): p. 1592-601.

Self-care capacity: Assess and describe baseline and current functional abilities by collecting data from multiple sources, and developing a preliminary management plan for patients presenting with functional deficits; and identify and assess safety risks in the home environment, and recommend changes to mitigate these.

Suggested Literature

Extermann, M. and A. Hurria, Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol, 2007. 25(14): p. 1824-31.

Falls, balance and gait disorders: collect data on falls within the last year and record and interpret the findings; and construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment in fall patients.

Suggested Literature

Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc, 2011. 59(1): p. 148-57.

Perioperative care of elderly cancer patients: appraise the patient’s conditions, functional status and risk: of cardiac, pulmonary, renal, geriatric, hematologic, neuropsychiatric and other perioperative complications; and assist in proactive management of surgical patients to prevent /minimize complications.

Hospital care for elders

Identify potential hazards of hospitalization (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and postoperative periods, transient urinary incontinence, and hospital acquired infections) and prevention strategies.

Explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter use.

Explain the risks, indications, alternatives, and contraindications for physical and pharmacological restraints use in the older cancer patient.

Communicate the key components of safe discharge plan (e.g. accurate medications list, plan for follow-up), including comparing/contrasting potential sites for discharge.

Suggested Literature

Creditor, M.C., Hazards of hospitalization of the elderly. Ann Intern Med, 1993. 118(3): p. 219-23.This elective is only offered in 2 week blocks no 4 week blocks are available.

For the program calendar, please see the elective module dates section of our website

Sponsor(s)