gT Geriatrics

On your first day at the VA report to Geriatrics Department 1K-120, Administrative Office for Geriatrics (near Building 6) to meet Dr. Dinescu; please be in her office ready to go at 8:30AM. Plan to arrive a few minutes early on your first day so that you can call IT to re-activate your accounts should you need to do so.

Schedule

3 weeks of inpatient consults, one week of self-directed learning, and every Friday you will have didactics from Dr. Wheeler. Please note your specific schedule will be sent to you in the orientation email at the start of your rotation. On your inpatient weeks, you will have educational conferences from 1-4pm on Mondays.

SDL

During your self-directed learning (SDL) time you will do dedicated reading and geriatrics-related MKSAP questions. 

Objectives of the Rotation
  1. To teach the role of geriatrics in the care of elderly patient

  2. To teach application of geriatrics principles in the care for the elderly patient

  3. To teach the intertwining of palliative care and geriatrics principles in the care of elderly hospitalized patient

You will learn:
  • Geriatrics inpatient consult outline – the role and scope of geriatrics inpatient consultation   

    • To perform CGA

    • To prevent hazards of hospitalization

    • Medication management and avoiding polypharmacy

    • Discharge planning and transition of care

    • Dementia and delirium in elderly hospitalized patient

    • Advance Care planning

  • Comprehensive Geriatrics Assessment

  • Capacity assessment and advance care planning for the elderly patient                                                                                 

  • Hazards of Hospitalization

  • Dementia and delirium

  • Pain medication for elderly hospitalized patient  

  • Discharge planning and understanding post-acute levels of care

Helpful Tips
Calling the team for every new consult
  1. Calling the team for every new consult

    • How can we help you? Or Please tell me about the patient so I can be more helpful to you.

    • Explanation: What are we trying to achieve? E.g. symptoms management, GOCs, hospice, breaking bad news etc.

  2. What is the terminal dx, is it reversible?

  3.  Availability of treatments or lack of it?

  4.  Prognosis by medical team and consultants? Call specialist if needed

    • Explanation: days to week or weeks to months etc.

  5.  Hospital course (optional if team has time to discuss) or do thorough chart review

 

To write a consultation note:

I was consulted by [ x ] for [ x ] 

Always write recommendations in bullet points, very clearly.

  • Stop MS Contin 15 mg po Q8H ATC

  • Start MS Contin 45 mg PO Q8H ATC

  • Continue Oxycodone 10 mg po Q4H PRN for breakthrough pain

Discussed with Primary team [ ] 

 

For family meeting:
  1. Please make sure all disciplines are available

  2. Primary team should arrange family meeting

  3. Assess patient’s capacity

  4. Identify surrogate or POA

 

Discharging patient home, make a note of everything in CPRS
  • Surrogate/caregiver is aware of plan

  • Patient can swallow po meds

  • Patient has access to comfort meds

  • Hospice is initiated, if patient is going home with hospice

  • When is the first hospice visit?

  • DME being delivered