Geriatric Curriculum Overview: Attitudes / Knowledge / Skills
(as adapted from the Education Committee Writing Group of the American Geriatrics Society)

Attitudes
Students should:

• be aware of the various myths and stereotypes related to older people.
• recognize that ageism, like racism, affects all levels and aspects of society, including health professions, and can adversely affect optimal care of elderly patients.
• recognize that "the elderly" are a diverse group with different personalities, different values, different functional levels, and different medical illnesses, and understand that each person needs to be viewed and cared for as an individual regardless of chronological age.
• be open and willing to work with colleagues in other disciplines in caring for older patients.
• be aware of their attitudes about their own aging, disability, and deaths.
• be compassionate toward those who provide day-to-day care for frail elderly and the difficulties they face.
• appreciate the need for improving and optimizing older people's functioning rather than just focusing on diseases.

Knowledge
Basic science
Students must acquire knowledge of:

• the demography and epidemiology of aging, including the growth in numbers of older people and heterogeneity of the older population.
• theories of aging, including biochemical/molecular, cellular, genetic, and biopsychosocial.
• "normal" aging versus diseases at the molecular, cellular, tissue, and organism levels.
  • Normal aging is heterogeneous, affecting different tissues and organs in different individuals at different rates.
  • Preventable, reversible, and treatable aging processes need to be identified by practicing physicians and managed accordingly.
  • Loss of homeostatic control mechanisms may account for much of the aging process.
• anatomic and histologic changes associated with aging.
• pathology associated with normal aging and age-associated disease processes.
• the physiology of aging in various organ systems.
• pharmacologic issues in aging and relevance to therapeutic decisions.

Clinical
Students should be familiar with:

• common geriatric syndromes and conditions, and have a basic understanding of risk factors, causes, signs, symptoms, differential diagnoses, initial diagnostic evaluations, and preventive strategies. These geriatric syndromes, conditions, and related problems include:
  • dementia;
  • inappropriate prescribing of medications;
  • incontinence;
  • depression;
  • delirium;
  • iatrogenic problems, including consequences of hospitalization and bed rest;
  • falls;
  • osteoporosis;
  • sensory alterations, including hearing and visual impairment;
  • failure to thrive;
  • immobility and gait disturbances;
  • pressure ulcers;
  • sleep disorders; and
  • nonspecific presentations of disease.
• diseases and disorders that are more common to or that have particular features in older people. Although students' individual clinical experiences may provide greater or lesser exposure to these disorders, students should have at least broad knowledge of pathophysiology, presenting signs and symptoms, differential diagnoses, and initial diagnostic evaluations for common diseases for older people, including:
  • rheumatologic diseases (e.g., osteoarthritis, rheumatoid arthritis, temporal arteritis/polymyalgia rheumatica);
  • genito-urological diseases (e.g., benign prostatic hyperplasia, sexual dysfunction);
  • neurologic diseases (e.g., Parkinson's disease, stroke and transient ischemic attack, dizziness/syncope);
  • cardiovascular diseases (e.g., congestive heart failure, atrial fibrillation, valvular heart disease), and hypertension (diastolic and systolic);
  • endocrinologic diseases (e.g., type II diabetes mellitus, hyperosmolar nonketotic coma, hyper- and hypothyroidism, Paget's disease of the bone);
  • cancers of various organs, including breast, lung, colon, prostate, and hematologic malignancies;
  • infections, including pneumonia, tuberculosis, and urinary tract infections;
  • renal diseases (e.g., fluid and electrolyte disturbances);
  • gastroenterologic disorders (e.g., constipation, malnutrition, diverticulitis, diverticulosis);
  • psychiatric diseases (e.g., depression); and
  • others, such as fractures and amyloidosis.
• the presenting signs and symptoms of and appropriate referral for psychosocial problems and issues common to elders, including:
  • normal late-life changes, including retirement;
  • psychological problems, including affective disorders, psychotic disorders, anxiety disorders, responses to medical illness, depression, and substance abuse;
  • under-reporting of symptoms and illnesses;
  • sexuality and aging;
  • elder abuse and neglect;
  • suicide;
  • home safety;
  • community resources, including those used to prevent institutionalization; and
  • adaptation to care in alternative living situations, including long-term care facilities.
• disease prevention, including:
  • primary prevention (for example, exercise and nutritional and psychosocial interventions designed to maximize function and allow independent living);
  • secondary prevention with age-appropriate screening for diseases and identification of geriatric syndromes; and
  • tertiary prevention strategies (for example, rehabilitation and chemoprophylaxis in the post-myocardial infarction patient).
• ethical issues in geriatric care, including:
  • advance directives;
  • decision-making capacity;
  • euthanasia, assisted suicide;
  • health care rationing; and
  • pain management and end-of-life care.
• health care financing, including:
  • mechanisms and implications; and
  • Medicare, Medicaid, managed care, and capitation.
• cultural aspects of aging. Students should be familiar with the influence of culture and ethnicity on the aging process, health and disease perception, and access to medical care, with emphasis on:
  • demographic information for ethnic elders in the United States;
  • the heterogeneity of federally designated minority groups;
  • risk factors and disease prevalence in these elders; and
  • the components of culturally competent medical care.

Skills
Students must be competent in:

• performing the basic elements of geriatric assessment, including the standardized methods for assessing physical, cognitive, emotional, and social functioning as appropriate. For example, students should be able to conduct screening examinations for mental status, geriatric depression, and functional status (including activities of daily living and instrumental activities of daily living).
• physical diagnosis skills, including the ability to perform mobility and gait and balance assessments, recognizing normal versus abnormal signs of aging, and performing preoperative assessment.