STFM 2006 Manuscript
‘Falls and Balance in the elderly: Assessment and Management in Primary care’
Arvind Modawal, MD MPH
Associate Professor
Department of Family Medicine
Section of Geriatrics
University of Cincinnati College of Medicine
Email:
Overview of University of Cincinnati/Health Alliance Reynolds Physician Training Center for Geriatric Medicine - This Center was created in 2003 as a result of a 3-million dollar grant (2 million from Reynolds Foundation and matching one million from the Dean, UC College of Medicine) to Dr Gregg Warshaw, Director, Office of Geriatric Medicine at University of Cincinnati College of Medicine and colleagues to promote Geriatric Education in the medical school for medical students, residents, faculty and the community physicians and allied health professionals. The grant funding runs over four years 2003 – 2007.
Community primary care physician project: Four major topics of geriatric medicine identified by the need assessment of the Health Alliance physicians in Cincinnati area to include Poly-pharmacy, Falls and balance disorders in the elderly, Urinary incontinence and Dementia care. Development of ‘Falls in the Elderly Curriculum’ took place in the second year for education of community primary care physicians and health professionals since this was perceived a major problem in their practices.
Faculty from UC College of Medicine using case-based computer presentations with video clips on two visits to the physician groups interested in participating in this educational activity. The presentations used innovative question and answer sessions using audience response system (ARS) with the individual responses displayed on the screen generating interaction and discussion on the problem. Handouts consisted of leading articles, patient handouts and other practice material to be used by office staff in patient records. Faculty and physicians evaluated the project and presentations on each visit.
Primary care physicians liked the many educational tips given during the presentation to increase their knowledge of fall assessment and prevention using two interesting case studies of older fallers. Presentations and material increased awareness and interpretation of few easy to do clinical tests in their busy practice, for example, a Timed ‘get up and go’ test, Functional Reach test, Sharpened Romberg’s test, Single leg stance test beside understanding the role of many medical conditions, inappropriate medications and environmental factors in a falling older person.
Community physicians and practices, numbering about fifty and twenty respectively, who participated in the Reynolds educational activities are encouraged to carry quality improvement projects on ‘Falls in the elderly’ and other topics (poly-pharmacy, urinary incontinence and dementia care) covered over the years to improve patient care and office procedures and protocols.
Other parts of the Reynolds project includes a
Medical Resident curriculum: There is also a geriatric curriculum using simulated patients to teach diagnosis, evaluation and medical care of patients with different stages of dementia of Alzheimer’s disease with video monitoring and feedback at the Center for Competency Development and Assessment (CCDA) of the UC College of Medicine for medical residents and students. Residents from many specialties in the medical center do rotations through the CCDA and find the clinical experience valuable (often described as the best in their entire training by many).
Physician Faculty Scholars: Many specialists from Internal Medicine, Family Medicine, Psychiatry, Physical Medicine & Rehabilitation, Obstetrics and Gynecology, Emergency Medicine and Surgery are taking part as Reynolds faculty scholars and developing geriatric projects and curriculum related to their specialties. Subsequently, the participating physicians were encouraged to improve geriatric education in their specialty and to do a quality improvement process in their practices with the knowledge and skills gained by participation in the program.
Medical Student Scholars: learn about geriatric from educational lectures, materials, and geriatric rotations and by shadowing assigned geriatric faculty mentors at clinical sites throughout their school years and carrying out research projects.
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