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Resources for Geriatrics Education

NEW - "Educational Resources in Aging" (requires log in) - The site houses the complete inventory of aging-related curriculum products that have been created by the Reynolds project team, as well as toolkits, articles and websites relevant to aging and geriatrics care. We hope these resources will be useful as you care for increasing numbers of older patients. You may use your Brown email log-in information; if you do not have Brown email, please contact Renee Shield for access information."

Tools

Geriatric Assessment Tool Kit: http://web.missouri.edu/~proste/tool/
Site produced by University of Missouri, Columbia School of Health Professions, Department of Physical Therapy.  Link to multiple useful tools to assess functional status, fall risk, and much more.  PDF files for easy printing and use in offices. 

Geriatric Depression Scale - short form screen for depression

MMSE and Clock - Links to the Folstein Mini Mental State Examination (MMSE) and Clock drawing test, both screening tools for dementia.

Web Links

Hospice Talks and Resources - Compilation of educational resources including PowerPoint files on topics relevant to Hospice and Geriatric medicine shared by Joan M. Teno, MD, Professor of Medicine at Brown University.

Geriatrics at Your Fingertips, on-line version of the AGS produced pocket
textbook.

Geriatric Educational Resources for Instructors and Elders:
Long Island University posted site with resources for patients, instructors.

GERI Pearls - These downloadable pocket cards are short concise review of a geriatric topics developed by the University of Nebraska Medical Center, Department of Internal Medicine, Section of Geriatrics. Topics included: Aging Pharmacology, Constipation, Delirium, Dementia, Depression, Falls, Insomnia, Hospital Admission, Pain Management, Palliative Care, PreOp Assessment, Pressure Ulcers, Syncope, Urinary Incontinence and Weight Loss.

GeriatricWeb: comprehensive library of expert reviewed "best example" articles and chapters on a complete index of Geriatric topics and issues at http://geriatricweb.sc.edu/erb.cfm put out through USC School of Medicine.

Reuben D, Herr K, Pacala J, et al. Geriatrics at Your Fingertips 2005 Edition. Published by America Geriatrics Association. Text version or downloadable PDA version available on-line at www.americangeriatrics.org.

Fast Facts on palliative care. Quick one-page summary documents that answer common questions in palliative medicine produced by the American Academy of Hospice and Palliative Medicine.

Portal of Geriatric Education Online. On line clearing house of geriatric educational materials and resources, provided at the level of student, resident, and faculty. Sponsored by the Donald W. Reynolds Foundation.

Geriatric Educational Resources for Instructors and Elders - Long Island University posted site with resources for patients and instructors.

American Academy of Hospice & Palliative Medicine - list of peer reviewed resources - books, links to article PDF's and the Fast Facts on Palliative Care.

Elder Web
Comprehensive website with historical perspective and expansive information on Long Term Care.

The Online Geriatric University
Reynolds site in conjunction with the University of Miami and the State of Florida. Containseducation and training resources.

PowerPoint Presentations

Richard W. Besdine, MD: The Challenges of Safe and Effective Drug Use in Older Adults.

Richard W. Besdine, MD: Teaching Office Based Geriatrics - Introduction to comprehensive geriatric assessment, case based illustration of assessment tools, resources for faculty teaching.

Articles

Aravanis SC et al. Diagnostic and Treatment Guidelines on Elder Abuse and Neglect. AMA 1992 http://www.ama-assn.org

- AMA guidelines to recognize elder abuse and neglect and review of appropriate treatment and referral.

Bentley DW et al. Practice Guidelines for Evaluation of Fever in Long Term Care Facilities. JAGS. 2001; 49(1): 210-222.

- Reviews workup for fever in the LTC patient and indications for transfer to acute care facilities.

Coleman EA. Falling Through the Cracks: Challenges and Opportunities for Improved Transitional Care for persons with Continuous Complex Care Needs. JAGS. 2003; 51(4): 549-555.

- Review of areas of transition of care that lead to loss of continuity of care, and information loss that can adversely affect patient care. Suggestions for streamlining transition from NH to hospital and back to NH are provided.

Fick D et al. Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Arch Int Med. 2003; 167: 2716-2724

- Reviews the Beers Criteria - a basic list of medications to avoid in older adults. Increases understanding why older adults are a higher risk for adverse reactions and how to appropriately prescribe why this in mind.

Finucane T et al. Tube Feeding in Patients with Advanced Dementia: A Review of the Evidence. JAMA. 1999; 282: 1365-1370.

- Extensive review of the existing literature with a focus on all the different outcomes for which tube feeding is initiated in patients with advanced dementia. No data found to suggest that tube feeding improves outcomes such as survival, incidence of infection or pressure sores, or prevention of aspiration pneumonias.

Fulmer T et al. Progress in Elder Abuse Screening and Assessment Instruments. JAGS. 2004; 52(2): 297-304.

- Reviews existing screening tools that can help pick up elder abuse, highlights shortfalls and areas for improvement.

Inouye S. A Practical Program for Preventing Delirium in Hospitalized Elderly Patients. Clev Clinc J Med. 2004; 71(11): 890-896.

- Helps understanding of risk factors that predict delirium both internal and external and addresses prevention and recognition of delirium in the hospitalized patient.

Inouye S et al. A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. NEJM. 1999; 340(9): 669-676.

- Discusses risk factors that were successfully intervened on with prevention of delirium.

Leslie D et al. Premature Death Associated with Delirium: A One-Year Follow Up. Arch Int Med. 2005; 165: 1657-1662.

- Proved that delirium is a risk factor for death in the acute setting and that higher mortality persists up to a year out, with loss of life years in patients who suffered delirium during a hospitalization.

Loeb MB et al. Interventions to Prevent Aspiration Pneumonia in Older Adults: A Systematic Review. JAGS. 2003; 51(7): 1018-1022.

- Reviews the various prevention strategies for aspiration pneumonia - positioning, cuing, texture, tube feeding and critically analyzes the data to see which has evidence base.

McNicoll L et al. Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients. JAGS. 2003 51: 591-598.

- Improves recognition of patients at high risk for delirium and how to recognize delirium in the critically ill older adult and discusses clinical outcomes.

Nicole L. Shea Position Paper: Urinary Tract Infection in Long Term Care Facilities. Infec Control & Hospital Epidem. 2001; 22: 167-175.

- Discusses appropriate indications for screening for, treatment of including antibiotic choice and duration of UTI in LTC patients.

Schneider L et al. Risk of Death with Aytpical Antipsychotic Drug Treatment for Dementia: Metaanalysis of Randomized Placebo Controlled Trials. JAMA. 2005; 294: 1934-1943.

- Reviews the data that led to the FDA black box warning, but discusses the importance of keeping the clinical context of drug use in mind.

Tinetti M. Preventing Falls in Elderly Persons. NEJM. 2003; 348(1): 42-49.

- Review of falls with case discussion to highlight risk factor recognition, interventions and outcomes prevention.

Wang P et al. Risk of Death in Elderly Users of Conventional versus Atypical Antipsychotic Medications. NEJM. 2005; 353: 2335-2341.

- Reviews conventional agents in light of increased concerns after the FDA warning against atypical agents. Studies demonstrate similar if not worse increased mortality among users of conventional agents - they should not be used in lieu of the atypicals despite the black box warning.

Comments or Suggestions? Please contact:

Ana Tuya Fulton, MD
Assistant Professor
Division of Geriatrics, Brown University
Rhode Island Hospital
593 Eddy Street APC 424
Providence RI 02903
401-444-5248
401-444-3397 (fax)
email: atuyafulton@lifespan.org

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