Domain – Older persons’ health (guiding topics)

Multimorbidity

• Define multimorbidity and identify associated issues, including:
  • quality of life
  • use of healthcare services
  • hospitalisations
  • treatment burden
  • multiple medicines
  • mortality.
• Recognise the limitations of disease-specific guidelines in the context of multimorbidity:
  • chronic obstructive pulmonary disease
  • osteoporosis
  • cardiovascular disease
  • cerebrovascular disease
  • chronic kidney disease
  • diabetes
  • osteoarthritis
  • cancer.
• Clarify goals of care with patients.

Health assessment and preventive care

• Conduct a thorough health assessment and manage preventive care, including:
  • hearing
  • vision
  • continence – bowel and bladder
  • constipation
  • falls risk
  • chronic pain
  • wound care and prevention of pressure injuries
  • nutrition
  • oral health
  • mental health, including risk assessment and management
  • sexuality
  • alcohol and other drugs.
• Define frailty and be familiar with validated assessment tools.
• Consider neglect and abuse.
• Conduct assessments of functional, cognitive, decision-making and driving capacity.
• Screen for cancer, and recognise the diminishing value of some screening activities in older patients, including for the following cancers:
  • cervical
  • breast
  • bowel.
• Recommend and administer immunisations (age appropriate).
• Screen for and manage osteoporosis.
• Enquire about and assess safety in the home, identify concerns and act appropriately.

Acute conditions

• Recognise symptoms of infectious diseases early and manage appropriately.
• Manage patients with infectious diseases in a registered aged care facility (RACF), including isolation, testing, quarantine and infection control.
• Understand that emergencies, such as cardiac conditions, cerebrovascular accidents, trauma, delirium, etc, may present differently in older people and require different treatment goals.

Behavioural and psychological presentations

• Understand the importance of prompt recognition, assessment and treatment of:
  • delirium
  • dementia
  • depression
  • anxiety
  • insomnia.
• Be aware of the communication difficulties that may occur with cognitive decline in patients who do not speak English as their first language.

Recognise the importance of non-pharmacological treatment in the management of conditions commonly encountered in older people –> link

Palliative and end-of-life care

• Initiate conversations about advance care planning and support patients.
• Manage symptoms – be aware of symptoms encountered and management options.
• Provide psychological support for patients, families and carers.
• Communicate with interdisciplinary team members.
• Communicate with friends/family.
• Understand and incorporate substitute decision-making into patient care.
• Be aware of end-of-life law.

Medication management

• Identify patients who would benefit from a medication review.
• Understand the role of the pharmacist and work collaboratively to refer and incorporate feedback into patient management.
• Prioritise deprescribing.
• Manage short-term pharmacotherapy of severe behavioural and psychological symptoms, and understand and adhere to the ethical, legal and reporting requirements.

Legal and ethical

• Fitness to drive.
• Wills and testamentary capacity.
• Abuse of older people – reporting.
• Advance care planning.
• Enduring power of attorney.
• Guardianship.
• Voluntary assisted dying.

Healthcare system

• Effectively communicate across practice and RACF systems.
• Provide team-based care.
• Engage in case conferencing.
• Facilitate family meetings.
• Be aware of community services and resources.