UCSF AGRC ITT Course Syllabus


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AGRC Interdisciplinary Team Training in Geriatrics Course
Course Website
Fall 2009 (November 12 – December 17, 2009)

Note: You will need to have the Abobe Acrobat Reader installed on your machine to view some of the resources below.
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Course Faculty

Rebecca Conant, MD, Associate Clinical Professor, Director, UCSF Housecalls Program, Dept. of Medicine, Division of Geriatrics, UCSF

Susan Hyde, DDS, MPH, PhD, Associate Adjunct Professor, Dept. of Preventive & Restorative Dental Sciences, School of Dentistry, UCSF

Kirby Lee, PharmD, Assistant Clinical Professor, Dept. of Clinical Pharmacy, School of Pharmacy, UCSF

Lynda Mackin, MS, RN, NP, Associate Clinical Professor, Dept. of Physiological Nursing, School of Nursing, UCSF

Course Coordinator

Cary Speidell, email: cspeidell@medicine.ucsf.edu, phone: 476-6209

WEEK 1 (11/12): Introduction to the Interdisciplinary Team Training and Home Care/Medicare/Community Services

Handouts:

Required Reading

Weiss, R. L., Milone-Nuzzo, P., Zuber, R. F. (2003). A tool to assess homebound status. Home Healthcare Nurse, 21(11), 774-777.
Go to for this access to this article (UCSF access only).

Please skim the following resources (available on the Medicare website)
- "Medicare & You" 2009: Summary Handbook for Medicare beneficiaries. Found at: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf.
- Center for Medicare and Medicaid Services (2008). Your Medicare Benefits: Your Health Care Coverage in the Original Medicare Plan. Found at:
  http://www.medicare.gov/Publications/Pubs/pdf/10116.pdf.

Additional Resources

www.calnhs.org - California Nursing Home, Home Care Agency and Hospice Agency Comparisons
www.cahsah.org - California Association for Health Services at Home (916) 641-5795
www.cms.hhs.gov - Center for Medicare Services
www.medicare.gov - Has Nursing Home Comparisons, Home Health Comparisons, and enrollment information and criteria
http://www.aarp.org/healthcoverage/ -AARP website that explains Medicare and supplemental coverage
Home Care Compare Site
http://www.onlok.org/seniorhealth/index.asp - On Lok Lifeways Senior Health Program
http://www.ioaging.org/services/- Institute on Aging (IOA)
http://www.ioaging.org/services/programs/mssp/ - IOA Multipurpose Senior Services Program
http://mowsf.org/- Meals on Wheels of San Francisco
http://sanfrancisco.littlebrothers.org/- Little Brothers of San Francisco: Visitors to Older Adults
http://www.ucsfhealth.org/adult/patient_guide/homehealth.html - UCSF Medical Center Home Health Agency

Additional Recommended Reading

Rice, D. P. & Fineman, N. (2004) Economic implications of increased longevity in the United States. Annual Review for Public Health, 25, 457-473.
Medicare drug benefit realities: MedScape E journal commentary
http://www.medscape.com/viewarticle/464964
Eng, C., Padulla, J. & Eleazur, G. (1997). Program of all-inclusive care for the elderly (PACE): An innovative model of integrated geriatric care and financing. Journal of the American Geriatrics Society, 45, 223-23

WEEK 2 (11/19): Introduction to Geriatric Assessment & Mobility in the Home and in the Community

Introduction to Geriatric Assessment

Handouts:

Pocket Guide to Geriatric Assessment (in binder)
ITT Geriatric Assessment Worksheet
One Page Simple Geriatrics Screen
MoCA Test and Instructions
Try This: Katz Index of Independence in ADLs
Try This: Lawton Instrumental IADL scale

Required Reading:

UCSF AGRC Online Curriculum (http://ucsfagrc.org/curriculum_home.html):
Module 1: Demography and Epidemiology
Module 4: Assessment of the Geriatric Patient
Please note: You must complete the user survey each time you enter the curriculum site.

Additional Resources

John A. Hartford Geriatric Interdisciplinary Team Training Program Website. www.gitt.org
The Hartford Institute for Geriatric Nursing Initiative, Try This Series
Growth House Guide to Death, Dying, Grief, Bereavement, and End of Life Resources

Additional Recommended Reading

Geriatric Assessment. Palmer RM. Med Clin North Am. 1999 Nov;83(6):1503-23
Comprehensive Geriatric Assessment. Helping your elderly patients maintain functional well being. Rockwood K, Silvius JL, Fox RA. Postgrad Med. 1998 Mar;103(3):247-9, 254-8, 264.
Clark, P. (1995). Quality of life, values, and teamwork in geriatric care: Do we communicate what we mean? The Gerontologist, 35(3), 402-411.
Farrell, M., Schmidt, M. & Heinemann, G. (2001). Informal roles and stages of interdisciplinary team development. Journal of Interprofessional Care, 15, 281-295.
Hansen, H., Bull, M. & Gross, C. (1998). Interdisciplinary collaboration and discharge planning communication for elders. Journal of Nursing Administration, 29, 37-46.
Leipzig, R., Hyer, K., Wallerstein, S., Fairchild, S., Cassel, C. & Howie, J. (2002). Attitudes toward working on interdisciplinary health care teams: A comparison by disciplines. Journal of the American Geriatrics Society, 50, 1141-1148.
Qualls, S. & Czirr, R. (1998). Geriatric health teams: Classifying models of professional and team functioning. The Gerontologist, 28, 372-376.

Mobility in the Home and in the Community

Handouts

Required Reading

UCSF AGRC Online Curriculum (http://ucsfagrc.org/curriculum_home.html):
Module One: Demography and Epidemiology
Module Four: Assessment of the Geriatric Patient
Geriatric Lectures, "Falls in the Elderly" by Bree Johnston, MD, MPH, Found at: http://www.ucop.edu/agrp/docs/sf_falls.ppt

Additional Resources

Falls and Hip Fractures Among Older Adults, CDC Fact Sheet
Preventing Falls in the Elderly, Information for Patients and their Families

Additional Recommended Reading

Podsiallo, D & Richardson, S. (1991). The Timed Up and Go: A Test of Basic Functional Mobility for Frail Elderly Person. J Am Geriatr Soc, 39, 142-148.
Tinetti, M. E., Baker, D. I., McAvay, G., et al (1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med, 331, 821-827.
Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 1701-1707.
Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 1701-1707.

WEEK 4 (12/3): Medications

Handouts

Required Reading

UCSF AGRC Online Curriculum (http://ucsfagrc.org/curriculum_home.html):
Module 2: Biology and Physiology of Aging - Section 2.4 (Pharmacologic considerations)
Please note: You must complete the user survey each time you enter the curriculum site.

Additional Resources

California State Board of Pharmacy, Consumer Info: Consumer Tips at www.pharmacy.ca.gov
American Association of Retired Persons (AARP) at www.aarp.org

Additional Recommended Reading

Hughes CM. Medication non-adherence in the elderly: how big is the problem? Drugs Aging, 2004; 21(12):793-811.
Hanlon JT et al. Update on drug-related problems in the elderly. The American Journal of Geriatric Pharmacotherapy, 2003; 1(1):38-43.
Karki SD et al. Impact of a team approach on reducing polypharmacy. Consultant Pharmacist, 1991;6:133-137.
Montamat SC et al. Management of drug therapy in the elderly. New England Journal of Medicine, 1989; 321:303-309.
Williams B. Geriatric Therapy. In Koda-Kimble M, Young L (ed): Applied Therapeutics: The Clinical Use of Drugs. Philadelphia, Lippincott Williams & Wilkins. 2001: 97.9-97.11.

WEEK 5 (12/10): Oral Health

Handouts:

Oral Health Assessment Form

Required Reading

Vargas, Kramarow, Yellowitz. The Oral Health of Older Americans. Centers for Disease Control and Prevention. (Hardcopy in your course pack)
AGRC Online Curriculum
Module 4: Assessment of the Geriatric Patient – Section 4.2.6 – 4.2.16 (Oral and Dental Health)

Additional Resources

CDC Aims to Prevent Oral Diseases Among Older Americans
http://www.asaging.org/media/pressrelease.cfm?id=85

Additional Recommended Reading

Chavez EM and Ship JA. Sensory and motor deficits in the elderly: impact on oral health. J Public Health Dent 2000;60(4):297-303
Ship JA, Duffy V, Jones JA, Langmore S. Geriatric oral health and its impact on eating. JAGS 1996;44:456-464.

WEEK 6 (12/17): Ethics and Discussion

Handout

POLST http://www.finalchoices.calhealth.org/polst-form.html

Additional Resources

Conservatorship Paperwork - Capacity Declaration
Advance Health Care Directive Kit - Sample from the California Medical Association
Low Literacy California Advance Health Care Directive (in various languages) http://www.iha4health.org/default.aspx/MenuItemID/266/MenuGroup/_Home.htm

Additional Recommended Reading

Resolving Ethical Dilemmas. A Guide for Clinicians. Bernard Lo. 2000. Lippincott Williams & Wilkins. Chapters 8-13. Pages 69-111.
"Ethical Patient Care: A Casebook for Geriatric Health Care Teams."
Editors: Mezey, Mathy D.. Cassel, Christine, K., Bottrell, Melissa M., Hyer, Kathryn, Howe, Judith L., and Fulmer, Terry T. (2001) Johns Hopkins University Press.