Pre-requisite: PGY-2 and above: Family Medicine, Internal Medicine, Med-Peds, or Geriatric Fellows
Duration for Elective: 2 weeks
Rotation Director: Rebecca Spear, DO
Educational Objective
This two-week elective rotation offers resident physicians the opportunity to engage with the comprehensive care of older adults under the mentorship of experienced geriatricians at Maine-Dartmouth. The rotation is designed to provide a broad, hands-on experience across inpatient, outpatient, home-based, and long-term care settings, with a focus on best practices for dementia care and the management of complex geriatric syndromes. Students will gain a deeper understanding of the unique psychosocial and healthcare needs of rural older adults and develop practical skills in geriatrics. By the end of the rotation, residents will:
- Develop proficiency in assessing and managing common geriatric syndromes, including delirium, dementia, falls, and polypharmacy.
- Gain experience in dementia care, including diagnosing various types of dementia, managing behavioral symptoms, and implementing non-pharmacologic interventions.
- Learn how to conduct comprehensive geriatric assessments, addressing not only medical but also functional, cognitive, and psychosocial factors.
- Understand the unique challenges of providing healthcare to older adults in diverse settings, including the hospital, outpatient clinic, home, and long-term care facilities.
- Cultivate skills in interdisciplinary teamwork and communication, particularly in coordinating care among multiple clinicians in the geriatric population.
- Compare the unique needs of older adults living in rural settings and the strategies to support aging in place with those of older adults in more urban or suburban settings
Experiences and Procedures
- Inpatient Geriatrics Consultation: Residents will participate in inpatient rounds with the geriatric consultation team, providing clinical evaluations and contributing to the management of older adults admitted to the hospital with complex medical issues. Focus areas will include delirium, dementia with behavioral disturbance, polypharmacy, functional change, and frailty.
- Outpatient Comprehensive Geriatrics Evaluation: In the outpatient clinic, residents will participate in comprehensive geriatrics evaluations, which include assessments of medical, functional, cognitive, and psychosocial domains. They will work with the team to develop holistic care plans for older adults, with an emphasis on maintaining independence and quality of life, addressing age-related concerns such as multi-morbidity, and identifying factors that contribute to poor health outcomes in rural older adults, such as isolation and poverty. Residents will gain awareness of community resources for rural older adults and caregivers, such as area agencies on aging, and will learn about opportunities to be physician advocates and change agents for rural older adults.
- Home-Based Primary Care for Homebound Rural Older Adults: Residents will accompany the team on home visits to provide primary care to homebound patients. Home-based primary care is one approach for supporting rural older adults to age in place. This experience will include the evaluation of chronic disease management, medication reconciliation, and the challenges of delivering healthcare in the home environment. Special attention will be given to managing complex conditions, such as frailty, end-of-life care, and mobility limitations.
- Nursing Home Care & Dementia Care Best Practices: Resident physicians will rotate at local nursing home to participate in the care of residents, with a particular emphasis on dementia care and promoting best practices in communication, behavioral management, and person-centered care. The experience will include interdisciplinary collaboration with nursing staff, social workers, and rehabilitation professionals.
Housing
Maine Dartmouth Geriatric Medicine does not offer learner housing. Interested residents may seek reimbursement for housing expenses through the MERGE Collaborative. See the MERGE Housing Reimbursement Policy for more information.
