Universitat Internacional de Catalunya
Ageing, Pluripathology and Chronicity
Teaching staff
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
M.Victòria Farré Mercadé mfarre@uic.es (main coordinator)
Enric Garcia Restoy egarciar@uic.es
Other teachers
Margarita Carmona Sánchez mcarmona@cst.cat
Mireia Llonch Masriera mllonch@uic.es
Lluís Guirao Cano llguirao@gmail.com
Daniel Rodriguez González DRodriguez@cst.cat
Nicole Stantonyonge nicolesys@gmail.com
Introduction
The aging of our population is an evident reality that will increase in the coming decades, as the presence of chronic diseases and pluripathology or multimorbidity, defined by the presence of two or more chronic diseases.
For this reason, the World Health Organization (WHO) is committed to promoting and prioritizing knowledge in these areas with the aim of knowledge in these areas in order to improve their management with the aim of giving "life to the years", as prioritized in the WHO's as currently prioritized and promoted in the Decade of Healthy Aging (2021-2030), declared by the United Nations General Assembly in December 2020, which is the main strategy for building a society for all people of all ages, and builds on the framework of the Global Strategy on Ageing and Health (2016). https://www.who.int/es/initiatives/decade-of-healthy-ageing.
Therefore, we should not treat multimorbid and/or elderly patients just because their diseases, but in a comprehensive way taking into account their clinical, functional and social aspects, without forgetting their values and preferences. In this way, we will improve their state of health and quality of life, reduce possible avoidable complications and, in short, improve their care and the associated health care costs.
This course "Aging, pluripathology and chronicity" invites us to get to know the elderly patient with its different typologies, as well as the chronic and pluripathological patient, from the youngest to the oldest.
We will learn how to apply the best model of care to these patients from the detection of their individual needs, through an integral management and following a continuity in their care based on a person-centered interdisciplinary intervention.
Welcome!
M. Victòria Farré and Enric Garcia
Coordinators of the course
Pre-course requirements
None
Objectives
1.- The student will be able to identify the typologies of older adult, chronic, complex chronic and MACA patients and will be able to demonstrate their knowledge of the different models and levels of care for chronicity and their application in the clinical context.
their application in the clinical context.
2.- Demonstrate sufficient knowledge of the theories and physiology of development to understand
concepts such as atypical presentation, and functional loss. And demostrate respect to the older person.
4.- Demonstrate sufficient knowledge of pharmacology (pharmacokinetics and pharmacodynamics) in order to
understand the principles of prescription for the elderly, chronic pluripathological diseases with special attention to the
to pharmacological reconciliation, polypharmacy, drug interactions, adverse drug reactions, and potentially
reactions, and potentially inappropriate prescribing of medicines that meet the STOPP-START criteria.
STOPP-START CRITERIA.
5.- Understand the complex relationship between pathological processes, dysfunctions, handicaps and disabilities, and will be able to
6. Understand the complex relationship between pathological processes, dysfunctions, disabilities and incapacities, and be able to assess the consequences of the disease in the functional sphere. As well as
adaptation through technical adjustments and adaptation to the environment.
7.- As the manifestations of malaltia in these groups is often atypical, manifested by functional impairment and frequently influenced by social factors; an interdisciplinary approach is taken. The student must demonstrate a good understanding of team dynamics, appreciate the contributions of each member and participate in the team.
8.- Demonstrate competence in: obtaining information, communicating with patients with sensory and cognitive deficits, carrying out a detailed comprehensive assessment, drawing up a list of patients with sensory and cognitive deficits, carrying out a detailed comprehensive assessment, drawing up a list of patients with sensory and cognitive and sensory deficits, the implementation of a detailed comprehensive assessment, the elaboration of a list of problems and a prioritised treatment plan, and theproblems and a treatment plan establishing priorities, emphasising the promotion of functionality, independence and quality of life.
9.- Demonstrate an adequate approach to the most common syndromes and diseases among the elderly, and
chronic pluripathological patients including: mobility problems, instability and falls, common syndromes of mental health (dementia, depression, depression, etc.).
mental health syndromes (dementia, delirium and depression), incontinence (urinary and faecal incontinence), cardiovascular diseases (hypertension, HF and AMI), metabolic diseases (DM, osteoporosis, thyroid disorders, water and electrolyte imbalance), ulcers and electrolytes), pressure ulcers, frailty and sarcopenia.
10.- Apply the principles of management of complex illness in the elderly and in pluripathological chronic illnesses in activities such as rehabilitation and rehabilitation of the elderly.
in activities such as rehabilitation and medical care.
9.- Understands the principles of primary, secondary, tertiary and quaternary prevention and incorporates these principles
in their care for these groups.
10. Will understand the limitations in the application of conventional clinical practice guidelines, as well as the different aspects that make the management of chronic, multi-pathological and elderly patients complex.
Competences/Learning outcomes of the degree programme
- 01 - Recognise the essential elements of the medical profession, including ethical principles, legal responsibilities and patient-centered professional skills.
- 02 - Understand the importance of central principles, in particular of professional confidentiality for the benefit of patients, society and the profession.
- 03 - Know how to apply the principle of social justice to professional practice and understand the ethical implications of health in a changing global context.
- 04 - Develop professional practice with respect for patient autonomy, beliefs and culture.
- 05 - Recognize own limitations and the need to maintain and upgrade professional skills, with particular emphasis on autonomous learning of new knowledge and skills and motivation for quality.
- 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
- 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.
- 13 - Obtain and develop a clinical history that contains all relevant information.
- 14 - Perform a physical examination and a mental assessment.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 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.
- 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
- 24 - Establish good interpersonal communication skills that enables efficient and empathetic communication with patients, relatives, media and other professionals.
- 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
- 26 - Assume role in the prevention and protection from diseases, injuries or accidents and maintenance and promotion of health, both individual and at the community level.
- 27 - Recognize role in multidisciplinary teams, assuming leadership when appropriate, for the delivery of health care, such as interventions for health promotion.
- 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.
- 32 - Know how to use information and communication technology in clinical, therapeutic, preventive health care and research.
Learning outcomes of the subject
- Know the impact of aging on the functioning of the organs and on pathology; longevity and its demographic and epidemiological impact, as well as respecting the elderly and patients with/without multimorbidity.
- Knowing how to identify the types of elderly patients, chronic patients, complex chronic patients and MACA (advanced chronic disease according to NECPAL criteria).
- Know the most relevant national and regional healthcare models for addressing ageing, multipathology and chronicity.
- Know the different levels and care devices available for the management of elderly patients, with multiple pathologies or in a chronic situation, and know how to make the appropriate referral according to individual needs.
- Know the dynamics of the healthcare process, emphasizing the dynamics of multidisciplinary and interdisciplinary teamwork.
- Know the peculiarities of the disease in the elderly patient, the atypical presentation of the disease. Recognize, diagnose and guide the most frequent geriatric syndromes: frailty, dementia and delirium, falls, immobility, pressure ulcers, urinary incontinence, eating disorders (malnutrition), sarcopenia, chronic pain, elder abuse, visual disturbances and more frequent hearing, constipation.
- Recognize, diagnose and guide a patient with a geriatric profile through the Comprehensive Geriatric Assessment. Know the main functional, nutritional, cognitive-affective and social assessment tools.
- Know how to manage polypharmacy in chronic pathology and elderly patients to avoid inappropriate medications and prevent iatrogenicity.
- Know healthy lifestyle habits (diet, exercise, sleep hygiene) in elderly patients with multiple pathologies and chronic conditions. Know the programs that promote community health education in relation to the prevention and promotion of health.
- Know the basic principles of functional rehabilitation and prescription of physical exercise. Identify the functional impairment due to intercurrent acute illness and the limitations associated with prevalent comorbidity. Know the concept of intrinsic capacity.
- Recognise, diagnose and guide the rehabilitation needs of a chronic multimorbid patient, and in advanced age.
- Know the indications for the most common devices and technical aids.
- Recognize, diagnose and guide malnutrition in the elderly, chronically ill and multimorbid patient. Knowing how to apply hydration and nutrition measures in these groups.
- Recognize, diagnose and guide urinary incontinence syndromes.
- Recognize, diagnose and guide the syndrome of instability, balance disorder and falls. Know and know how to apply measures to prevent falls.
- Recognize chronic patients from a multi-pathological complex chronic patient, being able to analyze and address the therapeutic complexity.
- Recognize, diagnose and guide patients with the most frequent comorbidity profiles (cardiovascular diseases - including heart failure and HTA-, cerebrovascular disease and stroke, Chronic obstructive disease and pneumonia, diabetes, renal failure, osteoporosis)
- Know techniques for participation and integration of the core patient-carer-associations. Knowing the disease from the patient's perspective. Develop informative educational materials such as posters, videos.
- Recognize the role of caregivers and work on tools that encourage their training both in caring tasks and in their own self-care.
- Knowing how to recognize the social needs of elderly patients, with multiple pathologies or in a chronic situation.
- Know the medico-legal aspects in relation to the elderly, with multiple pathologies, chronic conditions or loss of autonomy.
Teaching and learning activities
In person
This 2024-25 academic year, teaching will be face-to-face. However, the modality of classes and exams will be subject to any changes related to epidemiological issues and the rules that may be in force at any given time
| Data | Hora inici (hh:mm) |
Hora fi (hh:mm) |
Modalitat | Nº sessió modalitat | Grup | Aula | Tema | Professor/a | Idioma Classe |
| 04/09/2024 | 16:00 | 18:00 | CM | TODOS | Aula teòrica | Envejecimiento, Pluripatología y Cronicidad | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 06/09/2024 | 16:00 | 18:00 | CM | TODOS | Aula teòrica | Actuaciones preventivas en el envejecimiento y enfermo crónico. Envejecimiento activo | LLONCH MASRIERA, Mireia | Castellà/Català | |
| 09/09/2024 | 18:00 | 20:00 | CM | TODOS | Aula teòrica | Síndromes Geriátricos | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 16/09/2024 | 16:00 | 18:00 | CM | TODOS | Aula teòrica | Incontinencia urinaria | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 19/09/2024 | 14:00 | 16:00 | CM | TODOS | Aula teòrica | RHB y Cronicidad | GUIRAO CANO, Luis | Castellà/Català | |
| 20/09/2024 | 16:00 | 18:00 | LH | G4 | CISA | Interdisciplinariedad | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 20/09/2024 | 18:00 | 20:00 | LH | G2 | CISA | Interdisciplinariedad | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 27/09/2024 | 16:00 | 18:00 | CM | TODOS | Aula teòrica | Modelos de Atención a la Cronicidad.Atención Centrada en la Persona | CARMONA SANCHEZ , Margarita | Castellà/Català | |
| 01/10/2024 | 16:00 | 18:00 | TP | A | Aula teòrica | Nutrición en Envejecimiento, Pluripatología y Cronicidad | STANTONYONGE SESNIC, Nicole | Castellà | |
| 01/10/2024 | 18:00 | 20:00 | TP | B | Aula teòrica | Nutrición en Envejecimiento, Pluripatología y Cronicidad | STANTONYONGE SESNIC, Nicole | Castellà | |
| 02/10/2024 | 16:00 | 18:00 | Ex.Parcial | TODOS | |||||
| 04/10/2024 | 16:00 | 18:00 | LH | G1 | CISA | Interdisciplinariedad | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 04/10/2024 | 18:00 | 20:00 | LH | G5 | CISA | Interdisciplinariedad | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 08/10/2024 | 16:00 | 18:00 | TP | B | Aula teòrica | Consideraciones farmacologicas | LLONCH MASRIERA, Mireia | Castellà/Català | |
| 08/10/2024 | 18:00 | 20:00 | TP | A | Aula teòrica | Consideraciones farmacologicas | LLONCH MASRIERA, Mireia | Castellà/Català | |
| 08/10/2024 | 18:00 | 20:00 | LH | G3 | CISA | Interdisciplinariedad | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 14/10/2024 | 16:00 | 18:00 | LH | G2 | CISA | Abordaje Nutricional | STANTONYONGE SESNIC, Nicole | Castellà | |
| 14/10/2024 | 18:00 | 20:00 | LH | G5 | CISA | Abordaje Nutricional | STANTONYONGE SESNIC, Nicole | Castellà | |
| 17/10/2024 | 16:00 | 18:00 | TP | A | Aula teòrica | Deterioro Cognitivo. Delirium. Demencia | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 17/10/2024 | 18:00 | 20:00 | TP | B | Aula teòrica | Deterioro Cognitivo. Delirium. Demencia | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 24/10/2024 | 16:00 | 18:00 | TP | B | Aula mòvil | Inestabiliad y caídas | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 24/10/2024 | 18:00 | 20:00 | TP | A | Aula mòvil | Inestabiliad y caídas | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 29/10/2024 | 16:00 | 18:00 | TP | A | Aula teòrica | ABP Paciente Crónico (1) | GARCIA RESTOY, Enric | Castellà/Català | |
| 29/10/2024 | 18:00 | 20:00 | TP | B | Aula teòrica | ABP Paciente Crónico (1) | GARCIA RESTOY, Enric | Castellà/Català | |
| 30/10/2024 | 16:00 | 18:00 | LH | G3 | CISA | Abordaje Nutricional | STANTONYONGE SESNIC, Nicole | Castellà | |
| 30/10/2024 | 18:00 | 20:00 | LH | G4 | CISA | Abordaje Nutricional | STANTONYONGE SESNIC, Nicole | Castellà | |
| 06/11/2024 | 16:00 | 18:00 | TP | B | Aula teòrica | Escuela de pacientes A | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 06/11/2024 | 18:00 | 20:00 | TP | A | Aula teòrica | Escuela de pacientes A | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 07/11/2024 | 16:00 | 18:00 | TP | A | Aula teòrica | Escuela de pacientes B | GARCIA RESTOY, Enric | Castellà/Català | |
| 07/11/2024 | 18:00 | 20:00 | TP | B | Aula teòrica | Escuela de pacientes B | GARCIA RESTOY, Enric | Castellà/Català | |
| 13/11/2024 | 16:00 | 18:00 | TP | B | Aula teòrica | ABP Paciente Crónico (2) | GARCIA RESTOY, Enric | Castellà/Català | |
| 13/11/2024 | 18:00 | 20:00 | TP | A | Aula teòrica | ABP Paciente Crónico (2) | GARCIA RESTOY, Enric | Castellà/Català | |
| 21/11/2024 | 16:00 | 18:00 | TP | A | Aula mòvil | ABP Paciente Geriátrico (1) | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 21/11/2024 | 18:00 | 20:00 | TP | B | Aula mòvil | ABP Paciente Geriátrico (1) | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 22/11/2024 | 18:00 | 20:00 | LH | G1 | CISA | Abordaje Nutricional | STANTONYONGE SESNIC, Nicole | Castellà | |
| 28/11/2024 | 18:00 | 20:00 | CM | TODOS | Aula teòrica | Toma de decisiones en pacientes con multimorbilidad, y complejidad | GARCIA RESTOY, Enric | Castellà/Català | |
| 29/11/2024 | 16:00 | 18:00 | TP | A | Aula teòrica | Adaptación a la discapacidad | GUIRAO CANO, Luis | Castellà/Català | |
| 29/11/2024 | 18:00 | 20:00 | TP | B | Aula teòrica | Adaptación a la discapacidad | GUIRAO CANO, Luis | Castellà/Català | |
| 04/12/2024 | 16:00 | 18:00 | TP | B | Aula teòrica | Depresión y Transtornos del sueño | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 04/12/2024 | 18:00 | 20:00 | TP | A | Aula teòrica | Depresión y Transtornos del sueño | RODRIGUEZ GONZALEZ, Daniel | Castellà/Català | |
| 10/12/2024 | 16:00 | 18:00 | TP | B | Aula teòrica | Abordaje de la cronicidad desde la multidisciplinaridad:manejo social | CARMONA SANCHEZ , Margarita | Castellà/Català | |
| 10/12/2024 | 18:00 | 20:00 | TP | A | Aula teòrica | Abordaje de la cronicidad desde la multidisciplinaridad:manejo social | CARMONA SANCHEZ , Margarita | Castellà/Català | |
| 12/12/2024 | 16:00 | 18:00 | TP | B | Aula mòvil | ABP Paciente Geriátrico (2) | FARRÉ MERCADÉ, María Victoria | Castellà/Català | |
| 12/12/2024 | 18:00 | 20:00 | TP | A | Aula mòvil | ABP Paciente Geriátrico (2) | FARRÉ MERCADÉ, María Victoria | Castellà/Català |
Evaluation systems and criteria
In person
This 2024-25 academic year, teaching will be face-to-face.
The evaluation of the subject will be based on the following sections:
1) Theoretical part: midterm exam and final exam (they are mandatory): 75%
The final exam represents 60% of the final grade: written test of 60 multiple-choice questions (with 4 possible answers). 1/3 of the value of the question is deducted for each incorrect answer. Cut off point for passing in 5 out of 10.
The partial exam corresponds to 15% of the final grade: written test of 30 multiple-choice questions (with 4 possible answers). 1/3 of the question value is deducted for each incorrect answer. The cut-off point to pass is 5 out of 10.
The review of the exams will take place on the same day, immediately after the end of the test.
2) Exercises and group / individual group work
a) Attendance, work and participation in the Problem-Based Learning classes (TP9, TP11, TP12, TP13): 10% (5% of each ABP)
In the event that you do not attend a session and do not adequately justify it by sending the documentation proving the justification for the absence to the teacher responsible for the subject and the teacher of the class, the percentage corresponding to the session will be deducted lost ABP.
b) Group exercise “patient school” (RP8): 10%
If it is necessary to make changes to the ABP class group, patient school or skills laboratory, it will be necessary to request it, at least one week before the date of the class, sending an e-mail to the resonsible teacher of the subject and to teacher of the class and it will be necessary that the change has been previously agreed with a student from the other group, otherwise the change will not be carried out.
3) Professionalism, assertive participation, and reflective report: 5%
The reflective report must be submitted between December 12 and 23, 2024.
To pass the subject, you must have passed the final exam with a minimum of 5 out of 10. Under no circumstances will any test or extra exercise be taken to raise the final grade.
All those students who have a total final grade equal to or higher than 9 out of 10 will opt for honors registration which will be subject to the criteria of the teaching team of the subject, who will take into account professionalism, motivation, interest in the subject and the student's respect for teachers and peers.
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
Altres llibres i materials recomanats:
- Abizanda Soler, P, et al. Tratado de medicina geriátrica : fundamentos de la atención sanitaria a los mayores. 2ª edición. 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. 20ª edición, Rozman Borstnar & Cardellach Elsevier. 2016