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The elders speak: What older patients could tell their physicians in training about their health needs.

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Lynn LA, Hess BJ, Conforti LN, Lipner RS, Holmboe ES. — American Board of Internal Medicine

Presented: Association of Medical Education in Europe Conference, September 2009

Background: Physicians in training need to understand the health care needs of an aging population.

Work Done: The Care of Vulnerable Elderly Practice Improvement Module, a Web-based tool comprised of chart abstraction, patient surveys, and a practice-system survey was used to evaluate care of patients >65 delivered by residents in 19 U.S. internal and family medicine training programs. Information obtained from 1,000 patient surveys is compared against parallel measures from 1,893 charts audited by residents.

Patients responding to the survey were more likely to have fallen in the prior year (31% versus 12% identified by chart audit), have problems with balance or walking (46% versus 6%), bothersome urinary incontinence (22% versus 10%), difficulty walking up a flight of stairs (45% versus 9%), and difficulty walking ¼ mile (38% versus 12%). Differences in percents are statistically significant (p <.01). Patients also reported difficulties with activities of daily living not identified in chart audits.

Conclusions: Older patients frequently have ameliorable health problems or functional decline not noted by resident physicians.

Take-Home Messages: Patient surveys targeting common health problems in older adults can expand residents’ awareness of these conditions. Faculty and training systems must be prepared to address these problems, once they are identified.

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