I really enjoyed the long term care rotation at Metropolitan Hospital, which was done in the setting of a geriatric outpatient clinic. There were several differences in the patient population, compared to the generally younger patients that I previously saw, that I had to acclimate to. In addition, the staff was among the friendliest, and I was given more attention by the attendings than any other location I had been to previously. I learned a great deal about the pathophysiology of numerous chronic medical conditions, as well as how to work up more acute conditions, such as a fall. The geriatric assessment also became routine, and I learned the importance of documenting the patients abilities to care for themselves or ambulate effectively through their own home.

The most difficult aspect of the geriatric population is grappling with the effect that many of them have some degree of cognitive decline. This can be due to a dementia process like Alzheimer’s disease or vascular infarcts, or more commonly a mild cognitive impairment that comes with aging. Some patients may have varying degrees of forgetfulness or ability to communicate, and so information must be attained through their home attendant or family members that act as caretakers. The elderly are also much more fragile, and I had to learn to be very gentle when performing physical exams. I learned that checking the feet is essential, to see if there are any venous lesions or toenail abnormalities that can affect walking, and that might prove difficult for the patient to reach or take care of on their own.

The attending physicians were wonderful and gave me personal lectures on any topic that I found interesting or wanted to explore. I learned a lot about various medications, and Beer’s Criteria, which is a list of medications that should be reconsidered in the elderly due to potentially very negative side effects, such as anti-cholinergic medications causing worsening delirium and confusion. My favorite lecture was learning about gait abnormalities, and the differences between spastic, high-stepping, Parkinsonian, and ataxic gaits, and what their potential causes might be.

Overall, I enjoyed geriatrics, I found the patient population to be very nice and agreeable, and the staff was excellent and knowledgeable. I don’t know if geriatrics is the right course for me at the moment, but this may change as I become older myself, and gain a deeper understanding of the complexities involved in geriatric care.