Geriatric Core Competencies

Adapted from Proposed Geriatric Psychiatry Core Competencies for Subspecialty Training (1)

Patient Care:

  • Residents will adapt interview style, to communicate effectively with older adults, compensating for hearing, visual and cognitive deficits. Residents will demonstrate respectful and caring behaviors in interactions with patients and their families.
  • Residents will gather accurate key information from the patient, collateral sources, and other health care professionals as needed to complete:
    • History
    • Mental Status Exam
    • Structured cognitive assessment (vascular, frontotemporal, Diffuse Lewey body dementia spectrum, Alzheimer’s)
    • Functional assessment
    • Medical/Neurological Assessments
    • Abuse assessments
    • Caregiver issues
    • Community and home assessment
  • Residents will develop a multiaxial diagnosis, incorporating the bio-psychosocial formulation as it relates to the elderly.
  • Treatment planning will incorporate a bio-psychosocial model, and enlist a multidisciplinary approach as relevant to the illness and circumstances.
  • The medical/psychiatric interface will be examined developing a comprehensive and organized approach to the evaluation of geriatric individuals with multiple medical co-morbidities.
  • Pharmacotherapy of geriatric psychiatric and cognitive disorders will be prescribed with particular attention to principles of geriatric psychopharmacology.
  • The resident will inquire about herbal/non-regulated medication use, and be aware of drug interactions.
  • The resident will become familiar with the benefits, risks and indications for ECT in older adults.
  • The resident will incorporate a developmental perspective in the formulation of geriatric cases as well as understanding the indications for the various psychotherapies and modifications required for elderly individuals.
  • The resident will be knowledgeable about social/community resources and support systems available to the geriatric patient.

Medical Knowledge:

  • Residents must demonstrate knowledge of the following geriatric psychiatry subject areas:
    • Biomedical
      • Normal aging changes in organ systems, sensory systems, and cognition
      • Principles of pharmacology and aging with attention to:
        • Pharmacokinetics and pharmacodynamics
        • Psychotropic use in older adults
        • Side effect occurrence in older adults
        • Risks of polypharmacy, and recognition and prevention of drug interactions - pharmacokinetic and pharmacodynamic
      • Appreciation of the various presentations of psychiatric disorders in the elderly, and the impact on functional status, morbidity and mortality, including: mood disorders, psychotic disorders, anxiety disorders, cognitive disorders, personality disorders, and other illnesses
      • Risks, prevalence and presentation of cognitive disorders
      • Recognition of the interplay between general medical conditions and psychiatric illness
      • Investigation and detection of delirium in patients at risk
      • Recognition of maladaptive response to psychosocial changes
      • Familiarity with psychological and behavioral therapeutic techniques
    • Sociocultural
      • Appreciation of cultural and ethnic differences among older adults
      • Familiarity with family and caregiving issues
      • Ethical issues in the care of older adults
      • Policy issues in the care of the elderly, including health insurance and prescription drug costs
      • End of life issue

Interpersonal and communication skills:

  • The resident will create and sustain a therapeutic and ethically sound relationship with geriatric psychiatric patients and their families from a spectrum of available ethnic, racial, cultural, gender, socioeconomic, and educational backgrounds.
  • The resident will use effective listening skills and adapt communication to accommodate sensory, cognitive and functional deficits of patients and provide information appropriately, with adequate accommodations for deficits.
  • The resident will communicate with other members of team.
  • The resident will facilitate learning of other residents and students.

Practice-Based Learning and Improvement:

  • Residents are expected to:
    • locate, critically appraise, and assimilate evidence from scientific studies and literature reviews related to their geriatric patients’ mental health problems to determine how quality of care can be improved in relation to practic;
    • facilitate the learning of students and other health care professionals, such as other residents, medical students, nurses, allied health professionals and other members of the multidisciplinary team; and
    • obtain and use information about their own population of geriatric psychiatric patients and the larger population from which their patients are drawn.

Professionalism:

  • Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse geriatric psychiatric patient population.
  • Residents are expected to:
    • demonstrate respect, compassion, and integrity; a responsiveness to the needs of geriatric psychiatric patients and society that supercedes self-interest; accountability to such patients, society, and the profession; and a commitment to excellence and on-going professional development;
    • demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, competence, guardianship, advance directives, wills, elder abuse, and business practices;
    • demonstrate sensitivity and responsiveness to patients’ culture, age, gender, disabilities, ethnicity, socioeconomic background, religious beliefs, political leanings, and sexual orientation; and
    • demonstrate responsibility for the care of geriatric psychiatric patients by responding to patient communications and other health professionals in a timely manner, using medical records for appropriate documentation of the course of illness and treatment, coordinating care with other members of the team, and providing coverage if unavailable.

Systems Based Practice

  • Residents are expected to:
    • become familiar with the diverse systems involved in the care of older patients and their families, and how to use and integrate these resources into a comprehensive psychiatric treatment plan;
    • become aware of community systems of care and know how to help patients access appropriate care and other support services such as the area agencies on aging, social work, etc,; and
    • practice cost effective care without compromising quality of care.

References

  1. Lieff S, Kirwin P, Colenda C. Proposed geriatric psychiatry core competencies. In Curriculum Resource for Subspecialty Training. http://www.aagponline.org/prof/gerpsych_cc.asp.
  2. CAGP Draft core competency guidelines for resident training - rotation specific objectives. September 7, 2004. http://www.cagp.ca/downloads/residentCoreCompetencies.pdf