Elective Course Description
Medical student completing the Geriatric Medicine rotation at MSKCC 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.
Learning Objectives
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Cognitive and behavioral disorders
a. Student must be able to 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.
b. Student must be able to, in an older cancer patients with delirium, urgently initiate a diagnostic work-up to determine the root cause and be able to develop a non-pharmacologic management plan for agitated demented or delirious patients. -
Medication management
Student must be able to 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. -
Self-care capacity
a. Student must be able to assess and describe baseline and current functional abilities in an older cancer patient by collecting data from multiple sources, and develop a preliminary management plan for patients presenting with functional deficits.
b. Student must be able to identify and assess safety risks in the home environment, and make recommendations to mitigate these. -
Falls, balance and gait disorders
a. Student must be able to ask all patients age greater than 65 years of age or their care givers, about falls in the last year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings.
b. Student must be able to in a patient who has fallen, construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment. -
Hospital care for elders
a. Student must be able to identify potential hazards of hospitalization for all older adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and postoperative periods, transient urinary incontinence, and hospital acquired infections) and identify potential prevention strategies.
b. Student must be able to explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter use in the older adult patient.
c. Student must be able to explain the risks, indications, alternatives, and contraindications for physical and pharmacological restraints use in the older cancer patient.
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.
- Extermann, M. and A. Hurria, Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol, 2007. 25(14): p. 1824-31.
- 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.
- Creditor, M.C., Hazards of hospitalization of the elderly. Ann Intern Med, 1993. 118(3): p. 219-23.
- O’Mahony, D STOPP/START criteria for ptentially inappropriate prescribing in older people: version 2. Age and Ageing ,2015;44:213-218.
