Complete Revised pdf
,Contents
Foreword by Professor Adam Gordon������������������������������������������������������������������������ vi
Foreword by Michael Vassallo��������������������������������������������������������������������������������� viii
Acknowledgments�������������������������������������������������������������������������������������������������������� x
About the Authors������������������������������������������������������������������������������������������������������� xi
Introduction���������������������������������������������������������������������������������������������������������������� xii
1. Acute Illness (Diagnosis and Management)����������������������������������������������������� 1
2. Basic Science and Gerontology����������������������������������������������������������������������� 28
3. Chronic Disease and Disability (Diagnosis and Management)������������������� 34
4. Cognitive Impairment (Delirium and Dementia)����������������������������������������� 64
5. Continence��������������������������������������������������������������������������������������������������������� 84
6. Falls and Poor Mobility����������������������������������������������������������������������������������� 93
7. Geriatric Assessment��������������������������������������������������������������������������������������108
8. Surgical Liaison�����������������������������������������������������������������������������������������������115
9. Intermediate Care and Long-Term Care�����������������������������������������������������119
10. Nutrition�����������������������������������������������������������������������������������������������������������126
11. Rehabilitation and Transfers of Care�����������������������������������������������������������131
12. Specialty Topics�����������������������������������������������������������������������������������������������143
Index�������������������������������������������������������������������������������������������������������������������������188
v
Complete Revised pdf
,Foreword by Professor Adam Gordon
Effective care for older people lies at The growing specialty of geriatric
the heart of modern healthcare deliv- medicine has such competencies at its
ery. Rapid population ageing around the core. Substantial work has been under-
globe has seen a shift in the age distribu- taken over the last decade to establish
tion of patients that present to healthcare expert consensus around core compe-
practitioners. Most acute hospital takes, tencies in geriatric medicine and to lay
or clinic lists, regardless of specialty, are them out in ways that they can be easily
increasingly filled by older people with taught and learned. In the UK, where
multiple complex long-term conditions geriatric medicine is well established
and/or frailty and/or disability and/or and is, in fact, the largest of the phy-
cognitive impairment. sicianly specialties, assessments have
This has challenged the traditional been added to higher specialty training
medical diagnostic paradigm. The pro- to ensure that those who are eligible to
cess of establishing differential diag- become geriatricians have demonstrated
noses, ruling things in or out through these competencies. The Specialty
tests, and initiating curative treatments Certificate Examination (SCE) tests
doesn’t hold true in the face of multiple the knowledge components of these
long-term conditions that interact in a competencies.
multifactorial way to present as atypi- Building an SCE is, in fact, a long,
cal geriatric syndromes. The evidence- highly structured and quality-controlled
based approach here is comprehensive process. It starts with the higher specialty
geriatric assessment—a multi-domain, training curriculum, developed through
multi-professional, assessment-driven expert consensus and honed over years
approach to build person-centred prob- of drafting and redrafting. Questions are
lem lists that drive case management. written by specialists in the field against
Comprehensive geriatric assess- the learning outcomes included in the
ment has a compelling evidence base. curriculum and then undergo multiple
Randomised controlled trials that com- iterations and stages of quality control
pare it with traditional models of care to ensure that they are unambiguous and
show that patients managed in this way correct. Finally, they are integrated into
have better functional and cognitive out- an exam in a way that covers a sufficient
comes and lower mortality. But deliver- breadth of the curriculum.
ing, and leading, comprehensive geriatric Producing a textbook to emulate the
assessment requires broad competencies, SCE is no small feat. With this volume,
ranging from subspecialty expertise in Drs Rahman and Woodford have done a
common presentations in older people superb job. They have mirrored the pro-
to an understanding of rehabilitation, cesses of blueprinting, drafting and qual-
palliative care, mental health, and how ity control that take place in the exam
multidisciplinary teams can interact preparation processes for SCE under the
under each of these headings to deliver stewardship of the Royal Colleges. It is
evidence-based gold-standard care. also impressive that they have taken time
vi
Complete Revised pdf
, Foreword by Professor Adam Gordon vii
to outline these processes, so that candi- higher specialty progress examinations
dates can understand both how questions for geriatricians internationally. There’s
are derived and the rigour that goes into also useful learning here for other hospi-
preparing the assessment process. tal specialists, for general practitioners,
The authors emulate the ‘single best for nurses and for allied health profes-
answer’ of the SCE examination. This is sionals who want to build their knowl-
peculiarly well suited to geriatric medi- edge around care of older people. There
cine. The point of a single best answer will never be enough geriatricians—other
question is to test not just knowledge but healthcare professionals will find their
also judgement. It is usually the case that jobs much easier, and more rewarding,
more than one answer is partially cor- if they bank the knowledge included in
rect. This, as a practising geriatrician, is these pages.
the decisional challenge that I face on a It’s important to realise that the SCE
daily basis. Multiple diagnoses, multiple covers only the knowledge-based com-
investigations and multiple management ponents of progress assessment in higher
plans, and combinations upon combi- specialty training. Geriatric medicine is,
nations of these, represent a panoply of though, a very hands-on specialty. Our
possibilities for the attending physician. British trainees demonstrate the pre-
This format is good not just because it requisite skills and attitudes through a
emulates what is used in the exam. It is series of workplace-based assessments.
good because it hones exactly the sort of Most geriatricians choose their specialty
decisional competencies required to be a because they enjoy the intellectual chal-
good geriatrician. lenge of managing complexity and uncer-
Within the topics listed are some tainty, but it is in our interactions with our
things that are difficult to test, includ- patients that geriatric medicine comes
ing questions around rehabilitation and to life. Drs Rahman and Woodford are
transfers of care. The challenge here is commended for breathing life and verisi-
usually to recognise what is required militude into the clinical scenarios in this
of doctors, and how their contributions book. If you’re a geriatrician and, having
interdigitate with the multiple other pro- worked through these problems, you feel
fessionals required to deliver care for the urge to get back on the wards, then
older people. The authors have captured you’ve chosen the correct specialty. If
this well. Rehabilitation does not start and you’re not a geriatrician, and you feel
end with the input of the geriatrician— the same urge, then you’ve become part
but a geriatrician’s input can be valuable, of the revolution that promises to deliver
particularly if informed by the types of the care that patients attending health-
expertise that the questions here will help care services actually need. Welcome.
hone. Vive la révolution!
The questions here will be, of course,
an invaluable resource to future geriatri- Adam Gordon
cians preparing for the SCE. They will be Professor of Care of Older People,
useful for geriatricians from outside the University of Nottingham
UK who want to hone and benchmark President-Elect, British Geriatrics
their knowledge against the curricular Society
outcomes included in one of the very few January 2021
Complete Revised pdf
,Contents
Foreword by Professor Adam Gordon������������������������������������������������������������������������ vi
Foreword by Michael Vassallo��������������������������������������������������������������������������������� viii
Acknowledgments�������������������������������������������������������������������������������������������������������� x
About the Authors������������������������������������������������������������������������������������������������������� xi
Introduction���������������������������������������������������������������������������������������������������������������� xii
1. Acute Illness (Diagnosis and Management)����������������������������������������������������� 1
2. Basic Science and Gerontology����������������������������������������������������������������������� 28
3. Chronic Disease and Disability (Diagnosis and Management)������������������� 34
4. Cognitive Impairment (Delirium and Dementia)����������������������������������������� 64
5. Continence��������������������������������������������������������������������������������������������������������� 84
6. Falls and Poor Mobility����������������������������������������������������������������������������������� 93
7. Geriatric Assessment��������������������������������������������������������������������������������������108
8. Surgical Liaison�����������������������������������������������������������������������������������������������115
9. Intermediate Care and Long-Term Care�����������������������������������������������������119
10. Nutrition�����������������������������������������������������������������������������������������������������������126
11. Rehabilitation and Transfers of Care�����������������������������������������������������������131
12. Specialty Topics�����������������������������������������������������������������������������������������������143
Index�������������������������������������������������������������������������������������������������������������������������188
v
Complete Revised pdf
,Foreword by Professor Adam Gordon
Effective care for older people lies at The growing specialty of geriatric
the heart of modern healthcare deliv- medicine has such competencies at its
ery. Rapid population ageing around the core. Substantial work has been under-
globe has seen a shift in the age distribu- taken over the last decade to establish
tion of patients that present to healthcare expert consensus around core compe-
practitioners. Most acute hospital takes, tencies in geriatric medicine and to lay
or clinic lists, regardless of specialty, are them out in ways that they can be easily
increasingly filled by older people with taught and learned. In the UK, where
multiple complex long-term conditions geriatric medicine is well established
and/or frailty and/or disability and/or and is, in fact, the largest of the phy-
cognitive impairment. sicianly specialties, assessments have
This has challenged the traditional been added to higher specialty training
medical diagnostic paradigm. The pro- to ensure that those who are eligible to
cess of establishing differential diag- become geriatricians have demonstrated
noses, ruling things in or out through these competencies. The Specialty
tests, and initiating curative treatments Certificate Examination (SCE) tests
doesn’t hold true in the face of multiple the knowledge components of these
long-term conditions that interact in a competencies.
multifactorial way to present as atypi- Building an SCE is, in fact, a long,
cal geriatric syndromes. The evidence- highly structured and quality-controlled
based approach here is comprehensive process. It starts with the higher specialty
geriatric assessment—a multi-domain, training curriculum, developed through
multi-professional, assessment-driven expert consensus and honed over years
approach to build person-centred prob- of drafting and redrafting. Questions are
lem lists that drive case management. written by specialists in the field against
Comprehensive geriatric assess- the learning outcomes included in the
ment has a compelling evidence base. curriculum and then undergo multiple
Randomised controlled trials that com- iterations and stages of quality control
pare it with traditional models of care to ensure that they are unambiguous and
show that patients managed in this way correct. Finally, they are integrated into
have better functional and cognitive out- an exam in a way that covers a sufficient
comes and lower mortality. But deliver- breadth of the curriculum.
ing, and leading, comprehensive geriatric Producing a textbook to emulate the
assessment requires broad competencies, SCE is no small feat. With this volume,
ranging from subspecialty expertise in Drs Rahman and Woodford have done a
common presentations in older people superb job. They have mirrored the pro-
to an understanding of rehabilitation, cesses of blueprinting, drafting and qual-
palliative care, mental health, and how ity control that take place in the exam
multidisciplinary teams can interact preparation processes for SCE under the
under each of these headings to deliver stewardship of the Royal Colleges. It is
evidence-based gold-standard care. also impressive that they have taken time
vi
Complete Revised pdf
, Foreword by Professor Adam Gordon vii
to outline these processes, so that candi- higher specialty progress examinations
dates can understand both how questions for geriatricians internationally. There’s
are derived and the rigour that goes into also useful learning here for other hospi-
preparing the assessment process. tal specialists, for general practitioners,
The authors emulate the ‘single best for nurses and for allied health profes-
answer’ of the SCE examination. This is sionals who want to build their knowl-
peculiarly well suited to geriatric medi- edge around care of older people. There
cine. The point of a single best answer will never be enough geriatricians—other
question is to test not just knowledge but healthcare professionals will find their
also judgement. It is usually the case that jobs much easier, and more rewarding,
more than one answer is partially cor- if they bank the knowledge included in
rect. This, as a practising geriatrician, is these pages.
the decisional challenge that I face on a It’s important to realise that the SCE
daily basis. Multiple diagnoses, multiple covers only the knowledge-based com-
investigations and multiple management ponents of progress assessment in higher
plans, and combinations upon combi- specialty training. Geriatric medicine is,
nations of these, represent a panoply of though, a very hands-on specialty. Our
possibilities for the attending physician. British trainees demonstrate the pre-
This format is good not just because it requisite skills and attitudes through a
emulates what is used in the exam. It is series of workplace-based assessments.
good because it hones exactly the sort of Most geriatricians choose their specialty
decisional competencies required to be a because they enjoy the intellectual chal-
good geriatrician. lenge of managing complexity and uncer-
Within the topics listed are some tainty, but it is in our interactions with our
things that are difficult to test, includ- patients that geriatric medicine comes
ing questions around rehabilitation and to life. Drs Rahman and Woodford are
transfers of care. The challenge here is commended for breathing life and verisi-
usually to recognise what is required militude into the clinical scenarios in this
of doctors, and how their contributions book. If you’re a geriatrician and, having
interdigitate with the multiple other pro- worked through these problems, you feel
fessionals required to deliver care for the urge to get back on the wards, then
older people. The authors have captured you’ve chosen the correct specialty. If
this well. Rehabilitation does not start and you’re not a geriatrician, and you feel
end with the input of the geriatrician— the same urge, then you’ve become part
but a geriatrician’s input can be valuable, of the revolution that promises to deliver
particularly if informed by the types of the care that patients attending health-
expertise that the questions here will help care services actually need. Welcome.
hone. Vive la révolution!
The questions here will be, of course,
an invaluable resource to future geriatri- Adam Gordon
cians preparing for the SCE. They will be Professor of Care of Older People,
useful for geriatricians from outside the University of Nottingham
UK who want to hone and benchmark President-Elect, British Geriatrics
their knowledge against the curricular Society
outcomes included in one of the very few January 2021
Complete Revised pdf