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TWH Orientation Geriatric Medicine

TWH Orientation Geriatric Medicine. Why Geriatrics? The MSH-UHN Continuum of Geriatrics Housekeeping Educational Opportunities. Ageing and Hospital Utilization in Central Toronto LHIN, 2005. Toronto Central LHIN, 2006. The Hazards of Hospitalization.

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TWH Orientation Geriatric Medicine

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  1. TWH OrientationGeriatric Medicine

  2. Why Geriatrics? • The MSH-UHN Continuum of Geriatrics • Housekeeping • Educational Opportunities

  3. Ageing and Hospital Utilization in Central Toronto LHIN, 2005 Toronto Central LHIN, 2006

  4. The Hazards of Hospitalization • Older people are particularly vulnerable to the risks of iatrogenic illness and functional decline. • The pathogenesis of functional and cognitive decline is complex and involves an interaction amongst: • the ageing process • comorbid and acute illnesses • the hospitalization process

  5. Conceptualizing Functional Decline The Hazards of Hospitalization Hostile Environment Depersonalization Bedrest / Immobilty Malnutrition / Dehydration Cognitive Dysfunction Medicines / Polypharmacy Procedures Functional Older Person Acute Illness + Possible Impairment Depressed Mood Negative Expectations Physical Impairment and Deconditioning Dysfunctional Older Person Palmer et al., 1998 (Modified)

  6. Trajectories of Functional Decline Baseline Admission Discharge 70+ Pts N=2293 57% Stable N=1311 45% Stable N=1039 65% Discharged with Baseline Function N=1494 20% Recovery N=455 12% Hospital Decline N=272 35% Discharged with Worse than Baseline Function N=799 18% Fail to Recover Pre-Hospital Decline N=402 43% Decline N=982 5% Pre-Hospital and Hospital Decline N=125 Covinksy et al., J Am Geriatr Soc 2003

  7. The Hazards of Hospitalization THE COST OF FUNCTIONAL DECLINE (Palmer, 1995) • The loss of independent functioning during hospitalization has been associated with: • Prolonged lengths of hospital stay • Increased recidivism • A greater risk of institutionalization • Higher mortality rates

  8. AMBULATORY INPATIENT MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital MSH/UHN Geri Med Consults MSH Geri Psych Consults MSH/TWH Orthogeriatrics MSH ACE Unit Mount Sinai / UHN Geriatrics Continuum COMMUNITY Home Based Primary/Geri CareMSH Reitman CentreTemmy Latner Home Palliative Care CCAC ICCP Partnership ER MSH/UHN GEM Nurses MSH ER Geri Mental Health Prog

  9. INPATIENT MSH/UHN Geri Med Consults MSH Geri Psych Consults MSH/TWH Orthogeriatrics MSH ACE Unit The TWH Geriatric Medicine Consults Team Is called the “MACE Team” (Mobile Acute Care of Elders Team) “We bring our multidisciplinary specialized geri services to you – wherever you are in the hospital” SW – Helen LevinPT – Nadia IanettiOT – Oriana MedeirosGeri Advanced Practice RN & Wound Care RN – Sandra TullyGeri Advanced Practice RN & GEM RN – Petal SamuelRD – Brenda WilsonSLP – Hayley Herman MD – YOU! RGP (Regional Geri Program) OfficeEast Wing, 8th Floor Room 410

  10. INPATIENT MSH/UHN Geri Med Consults MSH Geri Psych Consults MSH/TWH Orthogeriatrics MSH ACE Unit • Common RFR: • Delirium & dementia • Functional decline, falls • Diagnostic/treatment challenge • Goals of care and disposition

  11. INPATIENT MSH/UHN Geri Med Consults MSH Geri Psych Consults MSH/TWH Orthogeriatrics MSH ACE Unit Referral Process “On-Call” person is paged Add to signout + email to group Email to group (Sometimes you will be the “on-call” person even if you are assigned to be in clinic…)

  12. INPATIENT MSH/UHN Geri Med Consults MSH Geri Psych Consults MSH/TWH Orthogeriatrics MSH ACE Unit Automatic geriatric consultation for all fractured hip patients ≥65 years old Ortho PCC Email to Geri staff WHY? Reduce incident delirium Optimize pain management Address the issues of “falls” & bone health Enhance functional recovery Increase chances of discharge home Email to group

  13. n=126 admitted hip# patients ≥65 yo Geri Consult pre-op or <24h post-op Daily visits to follow 10 parameters Incident delirium 50 vs. 32% (ARR 18% NNT~6)

  14. Fractured Hip Patients: Geri vs. Med Consults Geriatrics MedConsults Perioperative risk assessment Resp issues requiring close frequent monitoring Management of anticoagulation blood glucose electrolyte abnormalities acute kidney injury • Mental status • delirium • pre-admission cognition • mood • Falls • Bone Health • Pain & nausea • Constipation • Medication rationalization • Disposition planning

  15. AMBULATORY MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital Please phone in to confirm the day before clinic: TRI Outpatient Clinics Ground Floor (Elm Street Entrance) Dr. Alibhai, Dr. Chau, Dr. Liberman Angela or Urooj or Gilleanne (416) 597-3422 x 3047 MSH AIMGP Area 4th floorDr. Goldlist, Dr. Ng, Dr. Sinha Jacqueline (416) 586-4800 x 8563

  16. AMBULATORY MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital Toronto Western Hospital, West Wing 5th Floor

  17. AMBULATORY MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital Toronto General Hospital, North Wing 7th Floor

  18. AMBULATORY MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital TRI 2nd Floor 12 Week Geriatric Day Hospital TRI Elm Street Entrance 1st Floor Intake Assessment to 12 Week Falls Prevention Program

  19. AMBULATORY MSH/TRI Geri Med Clinics MSH Geri Psych Clinic TWH Memory Clinic TGH Osteoporosis Clinic TRI Falls Prevention Program TRI Geriatric Day Hospital

  20. COMMUNITY Home Based Primary/Geri CareMSH Reitman CentreTemmy Latner Home Palliative Care CCAC ICCP Partnership http://www.seniorshousecalls.ca

  21. COMMUNITY Home Based Primary/Geri CareMSH Reitman CentreTemmy Latner Home Palliative Care CCAC ICCP Partnership http://www.seniorshousecalls.ca

  22. COMMUNITY Home Based Primary/Geri CareMSH Reitman CentreTemmy Latner Home Palliative Care CCAC ICCP Partnership

  23. ER MSH/UHN GEM Nurses MSH ER Geri Mental Health Prog

  24. House Keeping: Rounds UHN Rounds

  25. House Keeping: Sign-out Lists

  26. Educational Opportunities

  27. http://www.mountsinai.on.ca/education/geriatrics/resident-resources-and-schedules/http://www.mountsinai.on.ca/education/geriatrics/resident-resources-and-schedules/

  28. Questions?

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