Universitat Internacional de Catalunya

Ageing, Pluripathology and Chronicity

Ageing, Pluripathology and Chronicity
4
12099
5
First semester
OB
Main language of instruction: Spanish

Teaching staff


Dr. GARCIA RESTOY, Enric - egarciar@uic.es


Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:

Subject coordinators 

Enric Garcia Restoy             egarcia@uic.es

M.Victòria Farré Mercadé     mfarre@uic.es

Other teachers

Mireia Llonch Masriera         mllonch@uic.es

Ester Marco Navarro            emarco@uic.es

Assumpte Recasens Gracia   marecasens@uic.es

Julia Tárrega Camarassa      jtarrega@uic.es

 

Introduction

The aging of our population is an obvious reality and it’s increasing in the last decades, at the same time than chronic diseases and pluripatology or multimorbidity, defined by the presence of two or more chronic diseases. 

For this reason, the WHO (World Health Organization) is committed to promoting and prioritizing their knowledge, in order to improve their management to give “life to years”. We should not treat these patients for a single disease, but in a comprehensive manner, taking into account the health and social aspects, without forgetting their values and preferences. In this way, we will improve health status and quality of life, reduce possible complications, and ultimately, we will improve care and associated health costs. 

This subject "Aging, pluripatology and chronicity", invites you to know the elderly patient with its different typologies, as well as the chronic and pluripatological patient, from the youngest to the oldest. We’ll learn  how to apply the best care model according to these patients, based on the detection of their individual needs, which is characterized by a comprehensive management and follow a continuity in their care through a interdisciplinary intervention focused on the person.

Be welcomed!

 

M. Victòria Farré i Enric Garcia

Subject coordinators

Pre-course requirements

None

Objectives

1.-The student will know how to identify the typologies of fragile, geriatric, chronic, chronic, and MACA patients and will demonstrate enough knowledge about the different models and care levels of care for chronicity and its application in the clinical context.
2.-Demonstrate sufficient knowledge on the theories and physiology of ageing, in order to understand concepts such as the atypical presentation, and functional loss.
4.-It will demonstrate enough knowledge of pharmacology (pharmacokinetics and Pharmacodynamics) in order to understand the principles of prescription for the elderly, chronic pluripathological patients, paying special attention to pharmacological conciliation, polypharmacy, interactions, adverse drug reactions, and improper and inadequate prescription of medicines.
5.-Understand the complex relationship between pathological processes, dysfunctions, disabilities and disability, and will be able to evaluate the consequences of the disease in the functional sphere. As well as adaptation through technical aids and the adequacy to the environment.
6.-As the manifestations of the disease in these groups is frequently atypical, manifested by functional deterioration and frequently influenced by social factors; An interdisciplinary approach is carried out. The student will have to demonstrate a good understanding of team dynamics, appreciate the contributions of each member and participate in the team as a medical member.
7.-will demonstrate competence in: obtaining information, communication with patients with sensory and cognitive deficits, the implementation of a detailed comprehensive assessment, the elaboration of a list of problems and a treatment plan establishing priorities and emphasizing the promotion of functionality, independence and quality of life.
8.-it will demonstrate an appropriate approach to the syndromes and common diseases among older people, and pluripathological chronic patient including: mobility problems, instability and falls, habitual syndromes of mental health (dementia, delirium and depression), incontinence (urinary and fecal), cardiovascular diseases (HTA, IC and IAM), metabolic diseases (DM, osteoporosis, thyroid disorders, water and electrolyte imbalances), pressure ulcers, fragility and sarcopenia.
9.-Apply the principles of complex disease management in the elderly and pluripathological chronologically ill in activities such as rehabilitation, and medical assistance.
10.-It will understand the principles of primary, secondary, tertiary and quaternary prevention and will incorporate them in their attention to these groups.
11. You will understand the limitations in the application of conventional clinical practice guidelines as well as the different aspects that make the management of chronic, pluripathological, and elderly patients more complex.

Competences/Learning outcomes of the degree programme

  • 04 - Develop professional practice with respect for patient autonomy, beliefs and culture.
  • 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
  • 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
  • 11 - Understand and recognize the effects of growth, development and aging on the individual and their social environment.
  • 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
  • 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
  • 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
  • 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
  • 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
  • 19 - Propose preventive measures appropriate to each clinical situation.
  • 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
  • 27 - Recognize role in multidisciplinary teams, assuming leadership when appropriate, for the delivery of health care, such as interventions for health promotion.
  • 28 - Obtaining and using epidemiological data and assess trends and risks in health related decision-making.
  • 31 - Understand, critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret and communicate scientific and health care information.

Learning outcomes of the subject

- To know the repercussion of aging on the functioning of organs and on pathology. Longevity and its demographic and epidemiological impact.

- Know how to identify the types of fragile patient, chronic patient, complex chronic patient and MACA (advanced chronic disease NECPAL criteria).

- To know the most relevant national and regional care models for approaching aging, multiple pathologies and chronicity.

- To know the different areas of care available for the management of the elderly, with multiple pathologies or in a chronic situation, and to know how to make the appropriate referral according to individual needs.

- To know the dynamics of the care process, highlighting the multidisciplinary and interdisciplinary team work, roles and functions of the basic work unit and main paramedical disciplines.

- Know the peculiarities of the disease in the elderly patient. Recognize, diagnose and guide the most common geriatric syndromes: dementia and delirium, falls, immobility, pressure ulcers, urinary and fecal incontinence, eating disorders (malnutrition).

- Recognize, diagnose and guide a patient with a geriatric profile through the systematics of Comprehensive Geriatric Assessment. Know the main tools for functional, cognitive-affective and social assessment.

- To know how to handle polypharmacy in chronic pathology and elderly patients to avoid inappropriate medications and prevent iatrogenic.

- To know healthy living habits (diet, exercise, sleep) in elderly patients, with multiple pathologies and chronic conditions. To know the programs that promote community health education in relation to the prevention and promotion of health

- To know the basic principles of Functional Rehabilitation and prescription of physical exercise. Identify functional impairment due to acute intercurrent disease and the limitations associated with prevalent comorbidity.

- Recognize, diagnose and guide the rehabilitation needs of a chronic multi-pathological patient, and in old age.

- To know the indications of the most frequent orthoses and technical aids.

- Recognize, diagnose and guide malnutrition in the elderly, chronically ill and multi-pathological patient. Know how to apply hydration and nutrition measures in these groups of patients.

- Recognize, diagnose and guide urinary and fecal incontinence syndromes.

- Recognize, diagnose and guide the syndrome of instability, balance disorder and falls. To know how to adopt fall prevention procedures.

- Recognize and guide in its comprehensive management a complex chronic multi-pathological patient, being able to analyze and address the therapeutic complexity.

- Recognize, diagnose and guide patients with the most common comorbidity profiles.

- To know the medical-legal aspects in relation to the elderly, with pluripathology, chronicity situation or loss of autonomy.

- To know techniques of participation and integration of the nucleus patient-caregiver-associations. To know the disease from the patient's perspective. Develop educational outreach materials such as posters, videos.

- Recognize the role of caregivers and work on tools that encourage their training in both caring and self-care tasks.

- To know how to recognize the social needs of elderly patients, with multiple pathologies or in a chronic situation.

Syllabus

Unit 01. (CM1) Aging, Pluripatology and Chronicity. Demographic, epidemiological and technological transition. Definitions. The elderly subject, types. Biology and physiological changes of aging. Geriatric Comprehensive Assessment. Assistance levels.
Topic 02. (CM2) Decision making in patients with multimorbidity, pluripatology and complexity. Clinical practice guides and patients with multimorbidity, pluripatology and complexity. Most frequent comorbidities: diagnostic, prognostic and therapeutic implications. Cumulative complexity model. Minimally disruptive medicine Therapeutic complexity: factors and consequences.
Unit 03. (CM3). Geriatric syndromes: Definition and consequences. The Giants of Geriatrics and the new geriatric syndromes. Sarcopenia, Fragility.
Unit 04. (CM4) Models of Attention to Chronicity in our environment. Complex chronic patient (PCC), and MACA. Person-Centered Attention: concept, general principles and fundamental criteria. Areas of action and planning.
Unit 05. (CM5) General concepts on Rehabilitation and Chronicity: functional assessment, indications and contraindications of rehabilitation, rehabilitation program, multidisciplinary team. Functional rehabilitation in the patient with acute / chronic diseases.
Unit 06. (CM6) Pharmacological considerations and general principles of the prescription of drugs in Geriatrics and chronic pluripatological patient: Definitions and consequences of polypharmacy, hyperpolypharmacy, polytherapy and drug adherence. Pharmacodynamic and pharmacokinetic changes that appear in aging. Predisposing factors of therapeutic failure. Mechanisms to optimize polypharmacy: therapeutic reconciliation and pharmacological deprescription.
Unit 7. (CM7) Preventive Actions and health promotion. Satisfactory aging: healthy elderly care program. Definition and objectives of health prevention and promotion. Types of prevention (primary, secondary, tertiary, quaternary). Healthy old program: intervention in life habits, cardiovascular risk factors, vaccination program, screening more frequent neoplasms.
Unit 08. (LH1) The interdisciplinary session as a vehicle of the therapeutic plan. Interdisciplinarity concept. Objectives and limitations of the interdisciplinary team. Formal and informal interdisciplinarity. Nursing in geriatrics. Physical therapy and occupational therapy. Other disciplines involved in the care of the elderly and chronic patient.
Unit 09. (TP1) Nutritional aspects in the elderly, chronically ill and pluripatological patient. Definition. Causes. Diseases related to malnutrition. Consequences. Assessment of nutritional status. Nutritional requirements in the elderly. Treatment and prevention Nutritional supplements. Dysphagia: Definition and diagnosis. Causes. Treatment and types of diet.
Unit 10. (TP2) Cognitive impairment. Delirium Dementia. Clinical forms and neuropsychiatric complications. Diagnostic process and multidisciplinary therapeutic approach.
Unit 11. (LH2) Nutritional approach in the elderly, the chronic and pluripatological patient.
Unit 12. (TP3) Adaptation to disability: Medical prescription of orthotics and technical aids.
Unit 13. (TP4) Approach to chronicity from multidisciplinarity: social management. Interdisciplinary social management of the most prevalent chronic diseases.
Unit 14. (TP5) Instability and falls. Importance of falls. Epidemiology. Related risk factors. Assessment of patients at risk of falls. Prevention strategies Specific interventions Consequences of falls: hip fracture.
Unit 15. (TP6) Urinary, fecal incontinence and constipation: Definition. Epidemiology. Anatomy and physiology of urination. Changes in the lower urinary tract linked to aging. Clinical, psychosocial and economic impact. Clinical classification of types of urinary incontinence: concept, definition, causes and treatment.
Unit 16. (TP7) Depression and Sleep Disorders. Definitions and classification. Magnitude of the problem. Clinical manifestations and diagnostic evaluation. Treatment. Architecture of the dream in aging. Insomnia. Therapeutic approach.
Unit 17. (TP8,10) School of patients (presentation of works).
Unit 18. (TP 9,12 -BLP1-) Case Study 1: Chronic Patient patient. 

Unit 19. (TP11,13 -BLP2)) Case Study 2: Geriatric Patient. Comprehensive Geriatric Assessment.

Teaching and learning activities

In person



 

DISTRIBUCIÓ DE LA DOCÈNCIA DE: Envelliment, pluripat i cronicitat DATA: 06/09/2021
Versió: V6
CURS:5º Medicina ANY ACADÈMIC: 2021-2022
Hores Data Horari Modalitat Grup Tema Professor/a
2 8/9/21 18:00-20:00h CM1 TOT Envejecimiento, Pluripatología y Cronicidad MF  
2 9/9/21 18:00-20:00h LH1 G2 Interdisciplinariedad MF
2 10/9/21 14:00-16:00h CM2 TOT Toma de decisiones en pacientes con multimorbilidad, y complejidad EG
2 13/9/21 14:00-16:00h CM3 TOT Síndromes Geriátricos MF  
2 14/9/21 18:00-20:00h CM4 TOT Modelos de Atención a la Cronicidad.Atención Centrada en la Persona EG 
2 16/9/21 16:00-18:00h CM5 TOT RHB y Cronicidad. EM 
2 22/9/21 18:00-20:00h CM6 TOT Consideraciones farmacologicas MLL 
2 28/9/21 16:00-18:00h TP1 A Nutrición en Envejecimiento, Pluripatología y Cronicidad AR 
2 28/9/21 16:00-18:00h LH1 G5 Interdisciplinariedad  EG 
2 28/9/21 18:00-20:00h TP1 B Nutrición en Envejecimiento, Pluripatología y Cronicidad AR 
2 30/9/21 16:00-18:00h LH1 G1 Interdisciplinariedad EG
2 30/9/21 18:00-20:00h LH1 G4 Interdisciplinariedad EG
2 4/10/21 16:00-18:00h CM7 TOT Actuaciones preventivas en el envejecimiento y enfermo crónico. Envejecimiento activo MLL 
2 5/10/21 18:00-20:00h LH1 G3 Interdisciplinariedad EG
2 8/10/21 18:00-20:00h CM8 (PARCIAL) TOT EXAMEN PARCIAL   /  CORRECCIÓ D'EXAMEN  
2 14/10/21 16:00-18:00h LH2 G2 Abordaje Nutricional AR
2 14/10/21 18:00-20:00h LH2 G4 Abordaje Nutricional AR
2 22/10/21 16:00-18:00h TP5 A Inestabiliad y caídas MF  
2 22/10/21 18:00-20:00h TP5 B Inestabiliad y caídas MF  
2 26/10/21 16:00-18:00h TP3 A Adaptación a la discapacidad EM
2 26/10/21 18:00-20:00h TP3 B Adaptación a la discapacidad EM
2 29/10/21 16:00-18:00h TP9 A ABP Paciente Crónico (1) EG
2 29/10/21 18:00-20:00h TP9 B ABP Paciente Crónico (1) EG
2 2/11/21 16:00-18:00h TP2 A Deterioro Cognitivo. Delirium. Demencia DR
2 2/11/21 18:00-20:00h TP2 B Deterioro Cognitivo. Delirium. Demencia DR
2 4/11/21 16:00-18:00h LH2 G3 Abordaje Nutricional AR
2 4/11/21 18:00-20:00h LH2 G5 Abordaje Nutricional AR
2 8/11/21 16:00-18:00h TP6 B Incontinencia urinaria MF  
2 8/11/21 18:00-20:00h TP6 A Incontinencia urinaria MF  
2 11/11/21 16:00-18:00h TP12 A ABP Paciente Crónico (2) EG
2 11/11/21 18:00-20:00h TP12 B ABP Paciente Crónico (2) EG
2 15/11/21 16:00-18:00h TP8 B Escuela de pacientes A JT
2 15/11/21 18:00-20:00h TP8 A Escuela de pacientes A JT
2 26/11/21 18:00-20:00h LH2 G1 Abordaje Nutricional AR
2 29/11/21 16:00-18:00h TP7 B Depresión y Transtornos del sueño DR
2 29/11/21 18:00-20:00h TP7 A Depresión y Transtornos del sueño DR
2 2/12/21 16:00-18:00h TP10 B Escuela de pacientes B JT
2 2/12/21 18:00-20:00h TP10 A Escuela de pacientes B JT
2 9/12/21 16:00-18:00h TP11 B ABP Paciente Geriátrico (1) MF
2 9/12/21 18:00-20:00h TP11 A ABP Paciente Geriátrico (1) MF
2 13/12/21 16:00-18:00h TP4 B Abordaje de la cronicidad desde la multidisciplinaridad:manejo social JT
2 13/12/21 18:00-20:00h TP4 A Abordaje de la cronicidad desde la multidisciplinaridad:manejo social JT
2 16/12/21 16:00-18:00h TP13 B ABP Paciente Geriátrico (2) MF
2 16/12/21 18:00-20:00h TP13 A ABP Paciente Geriátrico (2) MF
2 22/12/21 14:00-16:00h EF   EXAMEN FINAL i correcció examen  

 

Evaluation systems and criteria

In person



This academic year 2021-22, teaching will face to face

The classes through online teaching will be those corresponding to the master classes (CM) and those of face-to-face teaching will be those corresponding to the skills laboratory (LH), and the Theoretical-practical classes (TP). However, face-to-face classes and exams will be subject to the epidemiological moment in which we find ourselves, and may be converted to another modality depending on the epidemiological status. 

The evaluation of the subject will have three parts: theoretical part (70%), practical exercises (25%) and professionalism (5%) 

1. Theoretical part: partial and final exam (compulsory): 75% 

a. The midterm exam corresponds to 15% of the final grade: it consists of a written test of 30 multiple choice questions (with 4 possible answers). 

b. The final exam represents 60% of the final grade: it consists of a written test of 60 multiple choice questions (with 4 possible answers). 

Regarding exams it should be noted that 1/3 of the question value is deducted for each incorrect answer and the cut-off point for passing is 5 out of 10. 

 

2. Exercises and group / individual work

a) Group work and participation in Problem Based Learning classes (TP 9,11,12,13): 10% (5% for each ABP).

In the event that a session is not attended and it is not adequately justified by sending the proving documentation to the professor responsible of the subject, the corresponding percentage of the lost ABP session will be deducted.

 

b)  “Patient school” group exercise: 10%.

 

c)  Carrying out the exercise "Physical Prescription Exercise" corresponding to the TP5 class "Falls ans Instability"  will be optional and may improve the final grade by contributing with an additional 5%. The deadline for submitting the exercise will be desembre 27th, 2021.

In case group changes are needed, it will be necessary to send a request, at least one week before the date of the class,   through an email addressed to the teacher in charge of the subject. It will be essential that the change has been previously agreed with another student from anothe other group, otherwise the change will not be possible.

 

3) Professionalism, assertive participation, and reflective report: 5%

The reflective report must be delivered between December 17th, 2021 and January 5th, 2022.

To pass the course, you must have passed the final exam with a minimum score of 5 out of 10. In no case there will be any extra test or exercise to raise the final grade.

All those students who have a total final grade equal to or greater than 9 out of 10 will opt for honors and their obtaining will be subject to the criteria of the teaching team of the subject, which will take into account professionalism, motivation, interest in the subject and the respect of the student towards the professors and classmates.

 

 

 

 

 

Bibliography and resources

Sociedad Española de Geriatria y Gerontologia. Tratado de Geriatria para residentes. https://www.segg.es/tratadogeriatria/index.html


- Pedro Abizanda Soler, et al. Medicina Geriátrica Una aproximación basada en problemas. Editorial Elsevier Masson 2020.

- Ministerio de Sanidad Servicios Sociales e Igualdad. Estrategia para el abordaje de la cronicidad en el sistema nacional de salud. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2012.

-   Bullich I, Elias T, Ferrando C, Salvà A, Sánchez P. Adequació de la xarxa sociosanitària en l’atenció a la cronicitat. In: Sociosanitari PD, editor. Barcelona: Departament de Salut; 2015. https://canalsalut.gencat.cat/web/.content/Documents/adequa_cronicitat.pdf

- Generalitat de Catalunya. Programa de prevenció i atenció a la cronicitat. Bases per a un model català d’atenció a les persones amb necessitats complexes. Conceptualització i introducció als elements operatius.  https://salutweb.gencat.cat/web/.content/_ambits-actuacio/Linies-dactuacio/Estrategies-de-salut/Cronicitat/Documentacio-cronicitat/arxius/doc_complexitat_final_5.pdf


Other recommended reference books and materials:

- Abizanda Soler, P, et al. Tratado de medicina geriátrica : fundamentos de la atención sanitaria a los mayores.       Amsterdam. Elsevier. 2020.

- Roller-Wirnsberger, R, Singler K, et al. Learning Geriatric Medicine. A Study Guide for Medical Student.   Springer, 2018.

- Harrison’s Principles of Internal Medicine.19th edition by Kasper D, Fauci A, Hauser S, Longo DL, Jameson L and Loscalzo J. et al. New York McGraw Hill. 2015

- Farreras Rozman. Medicina Interna. 18ª edición, Rozman Borstnar & Cardellach Elsevier. 2016



 

Evaluation period

E: exam date | R: revision date | 1: first session | 2: second session:
  • E1 22/12/2021 14:00h
  • E2 07/07/2022 14:00h
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