| Program Description |
MD GERIATRIC MEDICINE
Preamble:
The purpose of PG education is to create specialists who would provide high quality health care
and advance the cause of science through research & training.
Older Indians carry a large burden of disease and disability and pose a tremendous challenge for
the health sector as well as also social and economic infrastructure. Several initiatives of
Government of India namely: National Policy on Older Persons (1999), National Health Policy
(2015 draft), National Population Policy (2015), Maintenance and Welfare of Parents and Senior
Citizens Act, (2007) and the National Program for Health Care of the Elderly (2011, 2014), have
emphasized the need for provision of quality and specialized health care of the older population.
Specialized training in the field of gerontology and Geriatric medicine has become the need of the
hour to realize the state initiatives in old age care.
The purpose of this document is to provide teachers and learners illustrative guidelines to achieve
defined outcomes through learning and assessment. This document was prepared by various
subject-content specialists. The Reconciliation Board of the Academic Committee has attempted
to render uniformity without compromise to purpose and content of the document. Compromise
in purity of syntax has been made in order to preserve the purpose and content. This has
necessitated retention of “domains of learning” under the heading “competencies”.
Goals
The goals of these Guidelines are to create a cadre of health professionals in the care of the older people; who would:
i. provide comprehensive health care and rehabilitation of the elderly
ii. provide undergraduate and postgraduate training
iii. carry out research in geriatrics and gerontology
A. Cognitive domain
At the end of the course, the student should have acquired knowledge in the
following theoretical competencies:
1. To develop the ability to obtain a relevant focused history
2. To demonstrate the ability to appropriately diagnose, evaluate, and prescribe
treatment and preventive strategies for older adults.
3. To develop ability to prescribe, review and monitor appropriate medication
4. To be able to formulate a diagnostic and therapeutic plan for the older patient
according to the clinical information available and communicate the same
5. To understand and discuss the risks of treatments with patients and relatives so
that they are aware of risks and able to make decisions
6. To develop ability to manage/control infection in patients including risk of
cross- infection
7. To communicate effectively and sensitively with patients, relatives and carers
8. To be able to deliver bad news according to the needs of individual patients and
their relatives/ carers
9. To know and be able to apply the principles and laws regarding medical ethics
and confidentiality
10. To obtain valid consent from the patient
11. To develop the ability to perform audit of clinical practice
12. To work effectively with many teams and put the quality and safety of patient
care as a prime objective
13. To be able to perform a comprehensive geriatric assessment
14. To be able to diagnose and manage acute illness in older patients in a variety of
settings
15. To be able to diagnose and manage chronic disease and disability in older
patients in both hospital and home settings
16. To recognize, diagnose and manage a state of delirium presenting both acutely
or sub- acutely in older patients
17. To be able to assess and manage patients who present with dementia alone or
with other illnesses
18. To acquire knowledge and skills required to assess and manage urinary and
faecal incontinence in older patients
19. To be able to assess and manage older patients presenting with falls (with or
without fracture)
20. To be able to assess the nutritional status of older people and devise an
appropriate nutritional support strategy
21. To know how to assess the cause of immobility and declining mobility in older
patients and its management
22. To be able to assess, diagnose and monitor common types of leg and pressure
ulceration, surgical and other wounds in older patients
23. To be able to manage older patients with movement disorders
24. To be able to assess acutely ill orthopedic patients and their rehabilitation
25. To be able to assess and manage older patients with psychiatric conditions
26. To have the knowledge and skills to assess and advise appropriative palliative
care to older patients with malignant and non-malignant life-limiting diseases
27. To provide care for patients with acute stroke and chronic stroke-related
disability
28. To provide the post graduate student with advanced knowledge and skills to
assess and manage older patients presenting with falls (with or without injury)
or syncope
29. To develop knowledge and skills to assess and manage older patients with
fracture, particularly hip fracture and manage fracture risk
30. To develop knowledge and skills to assess and manage older patients with
gynecological problems
31. To identify the important concepts of patho-physiology of common diseases of
older people.
32. To be able to describe / define
anatomical and histological changes associated with ageing
pathology associated with normal ageing and age-associated disease
processes
biochemical, molecular, cellular, genetic theories of ageing
physiology of ageing effect of ageing upon pharmaco-dynamics and
pharmacokinetics
B. Affective Domain
The post graduate student:
1. Should be able to function as a part of a team, develop an attitude of cooperation
with colleagues, and interact with the patient and the clinician or other
colleagues to provide the best possible diagnosis or opinion.
2. Should always adopt ethical principles and maintain proper etiquette in dealings
with patients, relatives and other health personnel and to respect the rights of
the patient including the right to information and second opinion.
3. Should develop communication skills to word reports and professional opinion
as well as to interact with patients, relatives, peers and paramedical staff, and
for effective teaching.
C. Psychomotor domain
At the end of the course, the student should have acquired the following skills:
History taking in the elderly
Physical Examination of the old patient
Investigations in the elderly:
Policy and interpretation
Radiological, Hematological and Biochemical investigations
ECG
Urinalysis
Radioisotope tests/ Bone Scan
Imaging – Ultrasound, CT Scan, MRI
How much to investigate?
Concept of normal range
Nutritional Assessment
Investigation of heart diseases in old age
o Cardiac Arrhythmias
o Coronary Artery Disease
o Acute Myocardial Infarction
o Hypertension and Hypertensive Heart Disease
o Postural Hypotension
o Congestive Heart Failure
o Aortic aneurysm
o Bacterial endocarditis
o Peripheral vascular disease
o Deep Venous Thrombosis
Investigations of the Gastro-intestinal tract
o Disorders of the mouth/loss of teeth
o GERD / Hiatus Hernia/ Acid Peptic Disease
o Disease of the pancreas
o Diseases of the small intestine
o Diseases of the large intestine
o Fecal incontinence/ Constipation - prevention and management
o GI malignancy
o Disease of the liver and biliary System
Investigations of the genitor-urinary tract
o Urinary Tract Infection - diagnosis and management
o Benign hypertrophy and cancer of the prostate - diagnosis and
management
o Urinary incontinence/ Urinary retention- evaluation and management
Management of Psychiatric Illness
o Diagnosis and management of - depression, cognitive impairment/
dementia, anxiety state/ acute confused state/delirium
Investigations and management of endocrine disorders
o Diabetes
o Thyroid diseases
Investigation and management of neurological disorders
o Stroke
o Parkinson’s disease
Investigation and management of ;
o Osteoarthritis
o Osteoporosis
Investigation and management of:
o COPD/bronchial asthma/ cor pulmonale/ acute and chronic respiratory
failure
o Tuberculosis
o Pulmonary thromboembolism
o Pneumonia - cause, diagnosis and treatment
o Lung cancer
Malignancy in old age:
Investigation and Management
Early detection and Counseling
Surgery in the Elderly:
Pre-operative Assessment
Priorities for surgery
Surgical Emergencies
Fractures
Pathological fractures
Benign lesions
Gangrene - Amputation
Elective Surgery
Post-operative problems and Management
Anesthesia in old age
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