Five Weekend Care of the Elderly Certificate Course - Program Agenda

Weekend 1 Agenda
Weekend 2 Agenda
Weekend 3 Agenda
Weekend 4 Agenda
Weekend 5 Agenda


Weekend 1 Agenda
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Saturday January 14, 2012
Diagnosis and Management of Mild Cognitive Impairment and Dementia

Linda Lee, MD, CCFP, FCFP
Director, Memory Clinic, The Centre for Family Medicine FHT, Kitchener;
Assistant Professor, Department of Family Medicine, McMaster University, University of Western Ontario, and Queen’s University

This weekend will provide the family physician with an approach to the diagnosis and management of patients with mild cognitive impairment and dementia in ambulatory care.   Topics to be covered include: delirium, the clinical differentiation of the different kinds of dementias, management of driving issues, and separating patients that can safely be diagnosed and managed by the family physician from those requiring referral to a specialist.  As well, principles of pharmacologic and non-pharmacologic management will be reviewed.

Learning Objectives:

1. Describe the clinical features of delirium, its diagnosis, and management. List features which differentiate normal aging, MCI, and dementia, and describe office-based tests that can be used to assess cognitive, visuospatial, and executive function
2. Describe the clinical features that differentiate the various types of dementia. List findings which might suggest that the cognitively-impaired patient is unsafe to drive, and findings which would require reporting to the MOT. Describe an approach to assessment of capacity.
3. Describe current evidence for effect on cognitive function of diet, exercise, cognitive training, and social networks
4. Describe principles of non-pharmacologic management and pharmacologic management for different types of dementia
5. Discuss management of caregiver stress

07:30 - 08:00     Continental Breakfast

08:00 - 08:30     Welcome to the Course: 
Robert Lam, MD, CCFP, FCFP
Family Physician, Family Health Team and Consultant, Falls Clinic, University Health Network.  Attending Physician, Geriatric Rehabilitation Program, Toronto Rehabilitation Institute; Assistant Professor, Department of Family Medicine, University of Toronto

Review U of T Certificate Requirements for Completion and Attendance

08:30 – 08:40    Introduction
Linda Lee, MD CCFP

08:40 – 09:20    Delirium, Depression, and Reversible Causes 
Linda Lee, MD, CCFP

Delirium is a common, debilitating, costly, and at times, life-threatening condition. It is reversible and preventable.  This presentation will highlight the importance of prevention, assessment, and management of acute confusion in the older adult.

09:20 – 10:05    Is it Normal, MCI or Dementia?
Linda Lee, MD CCFP

This presentation will provide a review of features that differentiate normal aging, MCI and dementia and office-based cognitive testing that can be used in the assessment.

10:05 – 10:20    Nutrition Break
     
10:20 – 11:00    Executive Function
Linda Lee, MD CCFP

This presentation will describe the clinical manifestations of executive dysfunction and office-based tests that can be used to assess executive functioning.

11:00 – 12:15        What Kind of Dementia Is It?
Linda Lee, MD CCFP

This presentation will provide a review of clinical features that differentiate the various types of dementia, and an approach to diagnosis.

12:15 – 01:00        Lunch

01:00 – 02:15         Driving
Linda Lee, MD CCFP

This presentation will provide a review of findings that might indicate that the cognitively-impaired patient is unsafe to drive and require reporting to the Ministry of Transport, as well as an approach to how this information might be communicated to the patient.

02:15 – 02:30    Nutrition Break

02:30 – 03:30    Practice Procedure 
Obtaining Informed Consent and Capacity Testing
Robert Lam, MD CCFP, Mr. Ian Waters, MSW, social worker TWH &
Katie Stock, RSW, MSW

Cocktail Reception
4:00-6:00pm

Metropolitan Hotel

Sunday January 15, 2012

07:30 - 08:00    Continental Breakfast

08:00 – 09:00          Non-Pharmacologic Management
Linda Lee, MD CCFP
Sid Feldman MD, CCFP, FCFP
Chief, Department of Family and Community Medicine, Baycrest Geriatric Health care System; Assistant Professor and Director, Care of the Elderly Program, Department of Family and Community Medicine, University of Toronto

This presentation will provide a review of BPSD symptoms and important non-pharmacologic strategies such as URAF key-question approach and the PIECES approach. Additionally, this session will provide a brief overview of the influence of lifestyle factors such as diet, exercise, cognitive training, and social networking on the development of MCI and dementia.

09:00 – 10:15     Pharmacologic Management
Linda Lee, MD CCFP

This presentation will review practical aspects of the use of pharmacologic treatments in dementia.
       
10:15 – 10:30    Nutrition Break

10:30 – 11:30    Caregiver Stress and Resources
Maria Martinez, MSW, RSW & Melissa Persadie, MSW, RSW  

This presentation will provide an update on our understanding of the stress that caregivers experience in caring for patients with dementia and practical ways of screening and managing caregiver stress.  Handouts on easy to use screening tools and helpful community resources will be provided.

11:30 – 11:45     Discussion of Assignment
Diagnose Alzheimer’s disease in your practice or help a fellow colleague. 
Manage a patient with potentially unsafe driving ability,
Linda Lee, MD CCFP & Robert Lam, MD CCFP

11:45 – 11:50    Evaluation of Workshop

11:50 – 12:50        Lunch


Weekend 2 Agenda
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Saturday February 11, 2011
Approach to Physically Frail Elderly Patients with Falls

Joyce Lee, MD CCFP
Health Care of the Elderly Consultant physician, Geriatric Parkinson’s Program and Memory Clinic, Elder Care Program, North York General Hospital; Lecturer, Department of Family and Community Medicine, University of Toronto

This weekend will provide the participants an overview of the multifaceted approach to frail elderly patients with mobility problems. The physiological changes associated with aging, the diseases and conditions which contribute to balance and gait problems will be reviewed. The participants will learn practical approaches to assess fall risk, manage vertigo, and prevent future falls.

Learning Objectives:

1. Discuss the overall approach to the evaluation of frail elderly patients with falls. Understand the intrinsic and extrinsic factors which contribute to falls.
2. Discuss the physiological changes and various pathological conditions in the elderly that may increase the risk of falls, such as parkinsonism, vertigo, postural hypotension.
3. Learn practical maneuvers to evaluate and treat conditions related to falls.  Learn how to perform a gait and balance assessment and how to prescribe an appropriate gait aid.
4. Discuss sleep disorders beyond insomnia which impact upon the elderly.
5. Discuss how one would integrate the acquired knowledge about falls into one’s daily practice.

07:30 - 08:00    Continental Breakfast

08:00 - 09:30     Debriefing of Weekend 1: Diagnosis and Management of Dementia and Mild Cognitive Impairment Assignments
Linda Lee, MD CCFP & Robert Lam, MD CCFP
   
09:30 – 09:45    Nutrition Break

09:45 – 10:45    Evaluating a Physically Frail Elderly Patient with Falls
Robert Lam, MD CCFP

This presentation will review the problem of falls  in Canada and provide an approach to evaluation for family physicians.
     
10:45 – 11:45    Parkinsonism in the Elderly
Joyce Lee, MD CCFP

This presentation will provide an overview of the spectrum of parkinsonian disorders, the differentiating features, and tips on pharmacological and non-pharmacological management of motor and non-motor features. Relevant cases will be discussed to highlight the learning points.

11:45 – 12:30        Lunch

12:30 – 01:30          Dizziness (vertigo, disequilibrium)
Daniel Wong, MD FRCP(C)
Neurologist, Medicine Department, North York General Hospital

This presentation will provide a review of the neurological conditions causing the common complaint of “dizziness”. The approach to differentiating these conditions, and their management will be discussed.

01:30 – 01:45         Nutrition Break

01:45 – 02:45    Practice Procedure 
Practice measurement of postural vitals and differentiate between different causes of postural hypotension. Practice Dix-Hallpike and particle repositioning maneuver.
Joyce Lee, MD CCFP & Robert Lam, MD CCFP

02:45 – 03:45    Physiological Changes of Normal Aging
Patrick W Chu, MBBS MRCP(UK)  FRCP(Edin)
Physician, Day Hospital and Outreach Team, Geriatric Ambulatory Services, North York General Hospital

This presentation will explore cardiovascular, neurological, bone and joint and metabolic changes in the elderly as well as drug metabolism in the elderly.  

Sunday February 12, 2012

07:30 - 08:00    Continental Breakfast

08:00 – 09:00   Offic e Assessment of Balance and Gait Disorders in the Elderly
Robert Lam, MD, CCFP

This presentation will provide a practical approach gait disorders in the elderly.  “Senile gait” disorders are now felt to be early presentations of disease rather than normal aging.

09:00 – 10:00     Prescription Walking Aids
Andrea Diaz Domonkos PT
Physiotherapist, Toronto Rehabilitation Institute

This presentation will provide a hands-on introduction to gait aids used to optimize a patient’s mobility function.

10:00 - 10:15    Nutrition Break

10:15 - 11:15    Sleep Disorders in the Elderly – Beyond Insomnia
Joyce Lee, MD CCFP

This presentation will explore the sleep disorders which impact the quality of
sleep in the elderly. Cases will be used to illustrate these disorders and the approach to diagnosis and management.

11:15 – 11:30     Discussion of Assignments
Assess and manage an elderly patient of yours or a colleague’s who has fallen recently.  
Manage a patient who shows signs of Parkinsonism or co-ordination deficits.
Prescribe or assess a current walking aid for a patient. 
Joyce Lee, MD CCFP & Robert Lam, MD CCFP

11:30 – 11:40    Evaluation of Workshop

11:40 – 12:40        Lunch

Weekend 3 Agenda
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Saturday March 31, 2012
Mental Health and Chronic Pain Management

Bachir Tazkarji, MD, CCFP, ABFM
Care of the Elderly Physician, Geriatric Rehabilitation Program, Toronto Rehabilitation Institute; Lecturer, Department of Family Medicine, University of Toronto

This weekend will provide participants with an overview of anxiety in the elderly along with practical tips for anxiety management.  Acute and chronic pain issues, common diseases that present with pain, how to balance treatment choices while preserving the patient’s independence and quality of life as well as a discussion about polymyalgia rheumatica diagnosis and management will be reviewed.  Participants will learn about common neoplastic diseases and will identify when to screen or not to screen for common cancers and the controversy of PSA testing will be discussed.

Learning Objectives:

1. Describe an approach to elderly patients with anxiety.
2. Balance treatment choices for pain while preserving a patient's independence and quality of life.
3. Describe common neoplastic diseases and discuss factors that affect decisions to screen or not to screen.
4. Recognize signs of elder abuse in the family practice setting.
5. Demonstrate proper techniques for steroid join injection of shoulder and knee joints.

07:30 - 08:00    Continental Breakfast

08:00 - 09:30     Debriefing of Weekend 2: Approach to Physically Frail Elderly Patients with Falls Assignments
Joyce Lee, MD CCFP & Robert Lam, MD, CCFP

09:30 – 09:45    Nutrition Break

09:45 – 10:45    Chronic Pain Management
Paul S. Tumber MD, FRCPC
Pain Management Consultant, UHN and Mt. Sinai Hospital Wasser Pain Clinic Assistant Professor of Anesthesiology, University of Toronto

This presentation will address low back and neuropathic pain in the context of clinical cases.

10:45 – 11:45    Managing Anxiety In The Elderly:  A Practical Approach
Corinne Fischer MD FRCPC
Assistant Professor, Department of Psychiatry St. Michael's Hospital, University of Toronto

This lecture will touch upon common anxiety disorders in the elderly, including mood associated anxiety, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder and anxiety associated with cognitive impairment.  A brief description of how anxiety presents in the elderly will be provided as well as a description of the differential diagnosis and treatment strategies.  Finally, cases will be presented to reinforce what has been learned.

11:45 – 12:30        Lunch

12:30 – 01:30          Treatment of Common Cancers (eg. breast, prostate)
Bachir Tazkarji, MD, CCFP
Care of the Elderly Physician, Geriatric Rehabilitation Program, Toronto Rehabilitation Institute; Lecturer, Department of Family Medicine, University of Toronto

This presentation will describe general screening guidelines, identify reasons why we should continue or stop screening beyond what is recommended for the general population and will describe the benefit of screening for certain cancers beyond certain ages.

01:30 – 01:45         Nutrition Break

01:45 – 02:45    Practice Procedure 
Practice steroid joint injections of the shoulder and knee
Robert Lam, MD CCFP & Bachir Tazkarji, MD CCFP

02:45 – 03:45    Joint Pain in the Elderly 
Bachir Tazkarji, MD, CCFP & Angela Montgomery, MD, FRCPC


Sunday April 1, 2012
 
07:30 - 08:00    Continental Breakfast

08:00 – 09:00    Palliative Care 
Dr. Ray Berry BSc MD CCFP FCFP ABHPM
Medical Director, Long Term Care, Toronto Rehabilitation Institute; Assistant Professor, Department of Family and Community Medicine, University of Toronto

This presentation will focus on management of common symptoms in palliative care especially pain and nausea. General palliative care principles will also be reviewed.

09:00 – 10:00     PSA Screening
Nicholas Pimlott MD, CCFP FCFP
Associate Professor, Department of Family and Community Medicine, Women's College Hospital, University of Toronto

This presentation will offer case based, interactive discussion of commonly encountered issues in prostate cancer screening in the elderly.

10:00 - 10:15    Nutrition Break

10:15 - 11:15    Elder Abuse
Bachir Tazkarji, MD CCFP

This presentation will provide an overview of elder abuse including financial issues. 

11:15 – 11:30     Discussion of Assignments
Manage an elderly patient with chronic osteoarthritic or neuropathic pain. 
Manage an elderly patient with depression or anxiety.
Bachir Tazkarji, MD CCFP and Robert Lam, MD CCFP

11:30 – 11:40    Evaluation of Workshop

11:40 – 12:40        Lunch

Weekend 4 Agenda
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Saturday May 5, 2012
Management of Common Medical Problems in the Elderly

Paul Kita, MD CCFP
Attending Physician, Geriatric Rehabilitation and Assessment Unit
Providence Healthcare

This weekend will explore common medical problems presenting in the elderly (eg. Diabetes, cardiovascular, pulmonary, and renal disease).  Current guidelines will be reviewed as they pertain to the elderly.  Case studies will provide the basis for group work, highlighting Family Physician’s skills as chronic disease managers.  Pharmacological issues and advanced directives will also be highlighted.

Learning Objectives:

1. List drugs to avoid in the elderly and be able to explain reasons why
2. Calculate estimated renal clearance and modify treatment of elderly patients with poor renal and / or hepatic function
3. Discuss relevant management issues in type 2 diabetes, chronic renal insufficiency, congestive heart failure, atrial fibrillation and respiratory disease as they pertain to the elderly
4. Role play discussion of advanced directives with elderly patients suffering from chronic disease.
    

07:30 - 08:00    Continental Breakfast

08:00 - 09:30     Debriefing of Weekend 3: Mental Health and Chronic Pain Management Assignments
Bachir Tazkarji, MD, CCFP & Robert Lam, MD, CCFP

09:30 – 09:45    Nutrition Break

09:45 – 10:45    Type 2 Diabetes Mellitus in the Elderly
Paul Kita, MD CCFP & Debbie Kwan, BScPhm., MSc., FCSHP

This presentation will be a review of current best practices and will discuss treatment approaches in the context of a variety of cases.   
 
10:45 – 11:45    The Top Five Drugs to Avoid in the Elderly 
Debbie Kwan, BScPhm., MSc., FCSHP
Pharmacist, Family Health Team, Toronto Western Hospital
Assistant Professor, Leslie Dan Faculty of Pharmacy and Department of Family Medicine, University of Toronto

This section will discuss drugs and drug classes that should be used with caution in the elderly.  Evidence supporting the minimal use of these drugs will be presented and alternatives discussed.  Participants will work through various cases, assessing appropriateness of drug therapy in specific individuals.

11:45 – 12:30        Lunch

12:30 – 01:30       “Can I take that?” Drug Therapy in Renal and Hepatic Impairment
Debbie Kwan, BScPhm, MSc, FCSHP

Renal and hepatic function can decline as a person ages.  The vast majority of drugs are excreted primarily by these routes of elimination.  This section will use a practical approach to factors that should be taken into consideration when prescribing drug therapy in these individuals in order to minimize the occurrence of adverse events.

01:30 – 01:45         Nutrition Break

01:45 – 02:45    Practice Procedure
Advance directives and the elderly patient; when to change from active to palliative treatment.  Learn how to discuss advance directives with patients suffering from chronic disease.
Robert Lam MD, CCFP & Ian Waters, MSW, Registered Social Worker, Toronto Western  

02:45 – 03:45    Chronic Renal Insufficiency in the Elderly
Paul Kita, MD CCFP & Vanita Jassal, MD, FRCPC

This presentation will review normal changes that occur with ageing in the renal system and how these “normal” changes may predispose the elderly to disease, renal insufficiency, or systemic decline.  It will look at the current Canadian Guidelines for Chronic Renal Insufficiency and, using case studies identify clinical challenges and current controversies in chronic renal insufficiency in the elderly.  Finally, chronic renal insufficiency will be discussed in a group situation, highlighting practice experience and acknowledging where clinical practice and published guidelines may differ.

Sunday May 6, 2012

07:30 - 08:00    Continental Breakfast

08:00 – 09:00    Congestive Heart Failure
Kirsten Lindner, MD, CCFP

Heart Failure in the elderly is a common, costly, undertreated, and modifiable condition with significant implications for both the patient and the system.   This presentation will highlight important aspects of optimal assessment and management of older heart failure patients within the primary care setting.

09:00 – 10:00     Atrial Fibrillation
Kirsten Lindner, MD, CCFP

Atrial Fibrillation is a common disease in older adults.  It is the most commonly seen arrhythmia in primary care.   Timely diagnosis and optimal management can greatly improve quality of life, complications such as stroke, and mortality.  This presentation will provide a practical approach to the diagnosis and often misunderstood management of this disease.

10:00 - 10:15    Nutrition Break

10:15 - 11:15    Respiratory Issues in the Elderly 
Paul Kita, MD CCFP & Tony D'Urzo, MD, CCFP, FCFP

This presentation will provide a case based review of common respiratory problems (e.g, pneumonia, COPD)

11:15 – 11:30     Discussion of Assignment 
Manage one of the above medical problems (eg.  Congestive heart failure, chronic renal insufficiency) using information from this weekend.
Paul Kita, MD CCFP & Robert Lam, MD CCFP

11:30 – 11:40    Evaluation of Workshop

11:40 – 12:40     Lunch

Weekend 5 Agenda
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Saturday June 2, 2012
Approach to Elderly Patients with Failure to Thrive

Robert Lam, MD CCFP
Care of the Elderly Physician, Geriatric Rehabilitation Program, Toronto Rehabilitation Institute; Assistant Professor, Department of Family Medicine, University of Toronto

This weekend will provide the family physician with a practical approach to the medically frail elderly patient.  These patients may present with mild anemia, depression, fatigue or weight loss.  The management of symptomatic late onset hypogonadism (andropause) and menopause will be discussed as well as osteoporosis.  Related problems of urinary incontinence and constipation will be reviewed.  Pessary insertion and urinary catheterization are useful office procedures that will be demonstrated.

Learning Objectives:

1. Describe a practical approach to anemia presenting in a frail elderly patient.
2. Formulate an approach to urinary incontinence in elderly patients including nonpharmacological management.
3. Critique different approaches to constipation and choose a practical laxative treatment for your elderly patient.
4. Describe a practical approach to weight loss and fatigue in the elderly.
5. Diagnose elderly men with andropause or symptomatic late onset hypogonadism and compare management options.
6. Review the evidence for the management of menopausal symptoms.
7. Use the 2010 Osteoporosis Canada Clinical Practice Guidelines to calculate fracture risk and propose appropriate interventions to reduce fractures.
8. Demonstrate proper techniques to fit and maintain a pessary.
9. Demonstrate proper technique for urinary catheterization to determine post void residual bladder volumes.
    

07:30 - 08:00    Continental Breakfast

08:00 - 09:30     Debriefing of Weekend 4: Management of Common Medical Problems in the Elderly Assignments
Paul Kita, MD CCFP & Robert Lam, MD, CCFP

09:30 – 09:45    Nutrition Break

09:45 – 10:45    Approach to Patients with Anemia and Possible Occult Malignancies 
Robert Lam, MD CCFP & Amy Freedman, MD, CCFP, FCFP

This presentation will highlight the physiological changes in hemoglobin measures with normal aging and provide a practical approach to patients with mild anemia.  Common myeloproliferative and lymphoproliferative disorders including monoclonogammopathy of unknown significance (MGUS) and multiple myeloma will be covered.
     
10:45 – 11:45    Urinary Incontinence
Christopher Frank, MD, CCFP, FCFP
Care of the Elderly Physician, St. Mary's of the Lake Hospital; Associate Professor, Division of Geriatric Medicine, Queen's University

Problems with urinary incontinence (UI) and constipation are common in older patients but family physicians are not always sure of a practical approach to either problem. This session will use cases to develop an approach to management of urinary incontinence and constipation.

11:45 – 12:30        Lunch

12:30 – 01:30        Constipation and Laxative Treatments
Christopher Frank, MD, CCFP

Constipation is common in older patients seen in the office, hospital and long term care homes. This presentation will discuss the aging changes in bowel function that predispose patients to constipation and use cases to review causes and contributing factors and discuss treatment options in a variety of clinical settings. These cases will include thoughts on when to refer and the impact of constipation on atypical presentation in the elderly.

01:30 – 01:45         Nutrition Break

01:45– 02:45    Practice Procedure 
Learn how to insert a pessary. 
Christopher Frank, MD CCFP & Risa Bordman MD CCFP FCFP

Learn how to do urinary catheterization to determine post void residual
Christopher Frank, MD CCFP 

02:45 – 03:45    Weight Loss & Fatigue in the Elderly
Christopher Frank, MD, CCFP

Fatigue and weight loss are common problems in older patients but are not easy to manage in a family medicine setting. This session will use cases to review common medical, social and environmental factors contributing to this presentation. Less common but important geriatrics conditions such a polymyalgia rheumatica will be discussed as will mental health causes such as depression and dementia. Resources to assist with management of “failure to thrive” will be discussed.

Sunday June 3, 2012

07:30 - 08:00    Continental Breakfast

08:00 – 09:00    Menopause
Amy Freedman, MD, CCFP

This presentation will take an evidence-based look at the current treatment options for menopausal symptoms, with particular attention to decision-making in hormone replacement therapy.

09:00 – 10:00     Managing the Patient with Osteoporosis
Sid Feldman MD, CCFP

This session will consider how it feels to be kyphotic, will discuss osteoporosis pathology and exercise, and will look at the consequences of osteoporosis for the individual and for the health care system.  A review of osteoporosis risk factors will be explored through interactive group discussion.  Small group cases will be used to practice decision making regarding who needs BMd/xrays.

10:00 - 10:15    Nutrition Break

10:15 - 11:15    Andropause
Robert Lam, MD, CCFP

This presentation will provide an approach to symptomatic late onset hypogonadism.  Diagnosis and management options will be reviewed.

11:15 – 11:30     Post-Reflective Exercise and Closing Remarks
Robert Lam, MD, CCFP   

11:30 – 11:40    Evaluation of Session

11:40 – 12:40    Lunch