CODE 80800 ACADEMIC YEAR 2023/2024 CREDITS 2 cfu anno 6 MEDICINA E CHIRURGIA 8745 (LM-41) - GENOVA SCIENTIFIC DISCIPLINARY SECTOR MED/09 LANGUAGE Italian TEACHING LOCATION GENOVA SEMESTER 1° Semester MODULES Questo insegnamento è un modulo di: MEDICINE TEACHING MATERIALS AULAWEB OVERVIEW Old patient has a different physiology and more complicated pathology in comparison to the adults, and he needs a targeted approach. The multi-dimensional and customized analysis of aged person has to be learned according to information derived from practical clinical experience, mainly in the ward. In an aging world, it is essential to have some experience in the geriatric area, whatever the field you will work after graduation. AIMS AND CONTENT LEARNING OUTCOMES The student must be able: -to understand the European and Italian epidemiology, in particular the population demographic changes -to recognize the changes that the older person shows and know how to approach him/her clinically, psychologically and with humanity -to apply the international multidimensional evaluation methods (i.e. the “comprehensive geriatric assessment”) - learn about the various degrees of fragility, complexity and the elderly person's severe impairment - to know and be able to diagnose and treat the most common diseases of elderly (geriatric syndromes) - Set an effective analgesic therapy after a precise evaluation of pain - to implement the pathologic aging prevention, plan a healthy life, to know and apply a judicious and wise anti-aging therapy - to address the ethical and deontological problems in the elderly population, the undue treatment and palliation - to properly use the network of services for the elderly AIMS AND LEARNING OUTCOMES The student once acquired the core curriculum of geriatrics will be able to: evaluate the impact of age-related changes on the physiology, comorbidity and drug selection and prescription know the drugs that should be prescribed with caution or avoided to have full knowledge of the possible adverse events, food, diseases and molecules interactions with the drugs used in the elderly differentiate the clinical presentation of delirium, dementia and depression formulate a differential diagnosis and observe the clinical relevance of a patient with cognitive impairment; set the specific drug therapy and non-pharmacological assess the cognitive abilities of an elderly with memory problems establish the functional capacity of an elderly, including sensory conditions; perform a physical examination focused on elderly develop a plan to manage frailty and disability through environmental adaptation and social interventions; participate to a multidisciplinary team (UVG) identify safety risks to the patient's home and recommend appropriate changes analyze the falls, assess the gait and postural stability, interpret tests and set up a prevention and treatment plan check the family, social, environmental situation and the organization of life of the elderly assessing the life expectancy, the clinical condition, the patient's preferences, realistic goals for the a diagnostic screening and for a cure to know the the possibility of atypical presentations, orphan symptoms, shared symptoms of different diseases knowing how to assess pain even in the patient with dementia, how to set up a therapy and re-check it over time learn about palliative care and hospice care as a positive option for the patient know the risks of hospitalization, risk prevention and find a possible treatment know what are the limits and the risks of physical and pharmacological restraints set a discharge from a hospital or nursing home, with the review of medications, the follow-up, the signs of rehabilitation and the address correctly the patient and his family in the network of services know how to prevent and deal effectively with the pressure sores address the ethical and clinical problems in the last part of the patient's life TEACHING METHODS Plenary Lectures (10 hours and minimum 30 hours of clinical activities in the ward) Professional training in the ward for acute cases, in the intermediate care and with the outpatient care Students are invited to participate to the weekly departmental meetings on complex clinical cases and upgrading seminars. SYLLABUS/CONTENT Keep in mind the demographic aspects of aging in Italy and in the EU, emphasizing the clinical implications for the area of internal medicine and for the primary care Know how to utilize, according to the international guidelines, the specific tools for clinical approach (history and physical examination) of elderly patients Describe the distinctive aspects and the atypical presentation of geriatric pathologies Address the diagnostic, prognostic, therapeutic and rehabilitative peculiar features of oldest pathologic conditions and face the comorbidity, the "Geriatric syndromes", as well the "orphan" symptoms Define the concept of life expectancy in comparison to the common conditions in the elderly: polypathology, disability and frailty. Discuss the relationship between quality and “quantity” of life in the old, the respect and the value of senility and identify how aggressive can be a therapy Explain and critically discuss the principles and methodology of multidimensional geriatric assessment and prognostic indexes especially in relation to concept of "fragility" of complexity and clinical severity. Define the utility and the methods of access to geriatric care network depending on patient characteristics and local experiences Describe the lifestyles and practical approach to healthy aging; how to implement a preventive strategy and critically weighed anti-aging therapy Knowing the problems of mistreatment and abuses on the weak and frail old person, including restraints How to use the informed consent and the support services for the elderly. RECOMMENDED READING/BIBLIOGRAPHY Hazzard's Geriatric Medicine and Gerontology, Mc Graw-Hill 2017 Ham – Primary care geriatrics – Saunders 2014 Oxford’s handbook of geriatric medicine – Oxford 2012 TEACHERS AND EXAM BOARD FIAMMETTA MONACELLI Ricevimento: on student's request by sending email ( fiammetta.monacelli@unige.it) for a scheduled appointment ALESSIO NENCIONI Exam Board ALBERTO BALLESTRERO (President) FEDERICO CARBONE (President) FABRIZIO MONTECUCCO (President) SIMONE NEGRINI (President) ROBERTO PONTREMOLI (President) GIUSEPPE MURDACA (President and Coordinator of Integrated Course) LESSONS Class schedule The timetable for this course is available here: Portale EasyAcademy EXAMS EXAM DESCRIPTION A written / computerized preliminary test is based on n. 30 multiple choice questions on topics of Medicine and n. 30 multiple choice questions on Geriatrics. The written test of Medical Genetics consists in two cases of consultancy, different for each student and a short answer on the field is due. For each correct answer you will be awarded one point, zero points for each question not answered or wrong. For passing each test at least a 18/30 score has to be attained. The test is valid for the oral exam only for the session in which it was done. Final oral examination: a compilation of a medical records relating to a clinical case at the bedside with discussion. ASSESSMENT METHODS The test is done by a series of multiple-choice questions that are useful to check the effective acquisition by the student of essential information for the expected learning target about the integrated course. A score not lower than 18/30 it allows the student to pass the preliminary test. The second part of the exam is designed to assess the student's know-how in the area of the course and it contributes to the final score (max. 30): The ability to review in a critical way and treat the required arguments also from the practical point of view is appreciated; the accuracy, the clarity, the synthesis and speech fluidity are quality also esteemed; the skills for the approach to the patient, the respect, humanity and ability to ask questions and get appropriate answers will be evaluated Mastery of the knowledge and expertise in the personalization of medicine are considered priority, as the adoption of appropriate terminology, not overly technical, in the approach to the patient The score of 30/30 cum laude, it will be granted when the knowledge / skills of the field are outstanding. FURTHER INFORMATION Three complementary teaching activities (ADE) are available for students: The first concerns the approach to acute geriatric patient (at the Geriatric Clinic); the second is an experience in the outpatient clinic (memory clinic and oncogeriatrics); the third is the frequency in the intermediate care ward, spool between the acute care and the home or residential care. The thesis can be obtained from one of the teachers of Geriatrics and the list of themes will be available at the DiMI Student’s Office . The educational material will be available on the DiMI website.