Curriculum guidelines on the care of the elderly for internal medicine residency training programs
Article Abstract:
It is estimated that doctors trained in internal medicine will spend over half of their time treating elderly patients. To do this well, internists must diagnose and treat appropriately, but also appreciate the variability in needs of elderly patients. In addition, physicians should be knowledgeable about aspects of aging such as changes associated with normal and abnormal aging, common syndromes, and age-related differences in the course of diseases. An ability to deal with a variety of health care settings and to cooperate with other medical professionals is also important. In recognition of this, changes in internal medicine residency curriculum are presented to improve training in geriatrics. The guidelines for internists' training encompass attitudes, specific knowledge, skills, health care settings, and resources. Also discussed are considerations of the barriers to such training and their solutions. Respect for the elderly and their autonomy, appreciation of heterogeneity among the elderly, and willingness to consider family members' ideas are important. Knowledgeability in areas such as adjustment of drug treatment, ethical principles, nutritional needs of the elderly, issues related to surgery, and financing of health care are important. Skills in comprehensively assessing the elderly, choosing treatments that incorporate patients' values, and coordination of care in numerous settings should be acquired. Training should be accomplished through both lectures and in clinical settings. An appendix is included listing some diseases that require special attention elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Geriatrics in internal medicine: the time has come
Article Abstract:
The average age in the US population is becoming older, and people over 85 are the most rapidly increasing age group. The elderly have a higher level of disabilities and chronic diseases and are in need of special health care that should be available from knowledgeable practitioners. A large number of the elderly are treated by physicians trained in internal medicine. Since 1981, training in geriatrics has been recommended as a part of the residency for internists. New guidelines for this training are published in the November 1991 issue of The American Journal of Medicine. Initially, geriatric training focused chiefly on providing fellowship programs. The aim of providing a structured, required geriatric curriculum for internal medicine residents has not yet been universally implemented. Resistance of residents and faculty members, lack of training sites, and few patients have been mentioned as reasons for the delay in implementation. A lack of qualified faculty and few ambulatory and long-term care sites were found to limit training opportunities. Limited time in the curriculum is also a problem. However, geriatrics can be combined with other important areas and should be a priority. The increasing number of elderly patients should have knowledgeable and skilled doctors. A creative and directed effort is needed to generate the resources that will provide suitable training for internists in geriatrics. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Sleep disorders and their management: special considerations in the elderly
Article Abstract:
The elderly often complain of insomnia or inability to sleep and disordered or abnormal sleep patterns. In addition, elderly patients frequently have medical and psychiatric problems which may contribute to sleep disorders. Although reduced sleep time and changes in the nature of sleep are considered normal aspects of the aging process, studies show that at least five million older adults suffer severe sleep disorders and most do not receive treatment for their insomnia. Thirty-five to 40 percent of all sedative hypnotic prescriptions are written for persons over age 60 years, who make up only 12 percent of the United States population. Twenty-three percent of Americans over age 85 years live in long-term care facilities, and institutionalization is associated with an increased risk of sleep disorders and prescription of sedative hypnotics. For these reasons, when a sedative hypnotic drug is being tested, its effectiveness and safety in elderly patients should be thoroughly evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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