COURSE OUTLINE
Module 1: Diagnosing dementia
This module commences with the statistics and clinical significance of dementia. Common dementia diseases outlined include Alzheimer’s disease, Lewy body dementia, vascular dementia, frontotemporal dementia and younger onset dementia. Diagnosis information including history, early signs and symptoms, other cognitive impairment causes and inclusion/exclusion criteria are outlined. Examination options include observations, bedside tests, cardiovascular, neuro and mental health. Pathology and imaging options are discussed including screening tools and their advantages and disadvantages. The module then moves to the benefits of early diagnosis and concludes with applying the module learning to three case studies.
Module 2: Falls in the elderly
This module commences with the definition and statistics for falls in the elderly. Risk and prevention factors at both the community and individual level are considered. Predictors for fall risk include increasing age, history of falls, abnormal gait or balance and polypharmacy. Validated falls risk screening tools are discussed that lead to assessment and implementation of a management plan to reduce risk of falls and fall related injuries. As part of the assessment process, history, examination, intrinsic and extrinsic factors risk factors, home assessment and appropriate investigations support the development of a management plan. Medications that may increase falls risk are listed together with falls reduction programs for the patient and also for the clinical setting.
Module 3: Polypharmacy and how to manage it
This module begins with describing polypharmacy and the health considerations for medications in persons over 65 years. Inappropriate prescribing and over the counter medications puts elder patients at the risk of adverse drug reactions. The physiological changes in the elderly are outlined. The number of people being prescribed multiple treatments is rising and a suggested systematic approach to prescribing new medications and regular medication reviews are outlined, including a systematic approach to deprescribing. Factors to consider before prescribing a new medication include determining the goals of treatment, patient values/preferences, medications known to increase the likelihood of a prescribing cascade occurring and medication interactions. The process of Domiciliary Medication Management Reviews (DMMR) is outlined. The approach to deprescribing, including barriers, tapering of medications and medications commonly associated with adverse events are provided. The module concludes with key take home points.
Module 4: Osteoporosis
This module commences by describing osteoporosis and related statistics. Bone physiology and determinants of bone density are revisited and modifiable risk factors outlined. Fracture risk factors independent of Bone mineral density (BMD) are outlined and two calculators for assessing fracture risk are included. Recommendations for identifying patients to investigate for osteoporosis and bone mineral density testing are outlined. The management of osteoporosis is discussed from a non-pharmacological, lifestyle and pharmacological perspective. The module then discusses osteoporosis in men including risk factors. The module concludes with focusing on osteoporosis in young people including chronic diseases associated with lowered BMD, assessment and the principles of treatment of osteoporosis in children and adolescents.
Module 5: Palliative care - the essentials
This module begins with describing palliative care, care providers and patients eligible for palliative care. It focusses on the medical practitioner role including breaking the news, how the patient may feel, cultural awareness, goals of care and having the difficult conversations. Pain assessment is discussed including diagnostic tools, types of pain and managing pain by both non-pharmacological and pharmacological methods. Options of pain management are discussed including working through a case study. The module then moves to symptom management of the gastrointestinal tract including nausea and vomiting, constipation and bowel obstruction. The module concludes with further symptom management including dyspnoea, fatigue, mood and anxiety, including dosage and delivery modes.
Module 6: Depression in the elderly
This module begins with an overview of depression and the increasing higher levels of psychological distress for older people. The content includes information on understanding depression, depression categories and how the medical profession defines depression. It then moves to the causes of depression, risk factors for the elderly, and other causal factors including at-risk groups. The effects of depression and how they may be displayed are mentioned, then considers diagnostic information, screening and assessment tools. Assessing suicide risk, differential considerations and investigations are outlined. The GP Mental health Care Plan and treatment approach includes education, lifestyle changes, psychological and medication considerations. The module concludes with two clinical case studies.
Module 7: Nutrition in the elderly
This module commences with looking at the causes and effect of malnutrition in the elderly. Included are the physiological effects of ageing on the gastrointestinal system and other clinical manifestations including anorexia. Understanding undernutrition in the elderly includes screening assessment tools and information on management techniques. Undernutrition is also often associated with people with dementia. The module then moves to obesity in the elderly including sarcopenic obesity. Approaches to weight loss in the elderly are included. The module concludes with an overview and guidelines of nutrient requirements in the elderly.
Module 8: Aged care services and residential aged care
The elderly are more likely to have complex and multiple health care needs and problems. The medical practitioner’s role in caring for the elderly considers family and other carer relationships and medical legal practicalities. This includes communicating with carers, recognising carer stress and when to recommend respite care. Complexities and options for caring for the elderly in the community including government subsidised services like the Commonwealth Home Support Programme and Home Care Packages. Transition, respite care and mental health care information is included together with information on retirement villages and supported accommodation options. The module then moves to how to apply for residential aged care facilities (RACF), ACAT assessments and considerations to achieving residential aged care. Services are discussed together with the transition process to supported accommodation. The module concludes with information on the medical practitioner role in providing care to residents in RACFs and includes Medicare information.