Geriatrics

Bridgeport Hospital is a thriving 425-bed community hospital with an active Section of Geriatric Medicine. The staff of 5 fellowship trained Geriatricians, 3 nurse practitioners, 5 nurse case managers, and an Emergency Room geriatric nurse case manager/patient advocate serve patients in the hospital, in the community and in long term care. Our dedication to academics and affiliation with Yale, give our community based program an academic edge. Our physicians are active in research and publications. They are leaders at the state level and travel frequently to national conferences to present case studies and original research. We are one of the few programs nationally with an Emergency Room program for our geriatric patients and have a very busy consult service.

Mission

The Geriatric Medicine Fellowship at Bridgeport Hospital is a community based fellowship program designed to prepare physicians for leadership positions in the field of Geriatric Medicine. With its strong emphasis on clinical care, our mission is to train physicians to be skilled in providing top notch, evidence based care for complicated, frail elderly patients in multiple sites and to be skilled in translating academic philosophy into quality patient care. Our goal is to train physicians who will be active clinical geriatricians and strong community leaders.

Overview

The Geriatric Medicine Fellowship at Bridgeport Hospital is a one year clinical fellowship with all the components to allow fellows to meet requirements for board certification in Geriatric Medicine. Fellows participate in the evaluation and management of a wide array of elderly patients in numerous settings including: inpatient and outpatient consultation, home care, assisted living facilities, and nursing home. Additional experiences will be provided in medical direction and administration, inpatient geriatric psychiatry care, outpatient non-institutionalized care via the REACH intensive outpatient program in geriatric psychiatry. Fellows will have contact with a wide array of disciplines during their varied rotations and will be required to have electives with Physical Medicine and Rehabilitation, Neurology, Psychiatry. They will participate in interdisciplinary team meetings at least weekly. Fellows will be expected to participate in clinical research and will be encouraged to present their research at a national meeting.

Schedules will vary monthly, but they will consist of 4 sessions of inpatient consultation, one session each of geriatric outpatient assessment, home visits, continuity care practice, and nursing home, and 2 sessions set aside for elective and research time.

We:

  • Perform 1200 + in-patient consults yearly
  • Perform 700 + outpatient consults yearly
  • Care for over 180 (and growing) homebound patients
  • Care for over 300 nursing home and assisted living patients
  • Serve as nursing home and assisted living facility medical directors
  • Consult with the state department of health to advocate for standards of care in nursing home practice
  • Teach at local, state, and national meetings
  • Perform research that is published in well known medical and nursing journals
  • Present posters and abstracts at national meetings

We entertain applications filed through ERAS.

Vivian Argento, MD
Associate Program Director

Conferences


Weekly didactic conference on a variety of topics

  • Fellows are required to prepare and present 2 sessions a year
Weekly case based discussion or morbidity and mortality report

  • Fellows are expected to bring a case for discussion weekly

Monthly research meeting with review of all ongoing research within the section

  • Monthly journal club
  • Fellows are expected to present 3-4 sessions a year
Monthly Geriatric Grand Rounds at Yale School of Medicine

Quarterly faculty development workshops

Fellows also have the option to attend:

  • Weekly Medical Grand Rounds at Bridgeport Hospital
  • Weekly didactic sessions for residents and other fellowship programs
  • Daily Internal Medicine resident morning report

Research


Fellows are asked to complete original research and a quality assurance project during their fellowship. They are encouraged to submit abstracts of their work to appropriate national conferences including the annual symposia of GSA, AMDA, and AGS. Each fellow is expected to present 1 poster at a national meeting.

Biology on Aging


Chutka DS, Evans JM, Fleming KC, Mikkelson KG. Symposium on geriatrics--Part  I: Drug prescribing for elderly patients. Mayo Clin Proc. 1995 Jul;70(7):685-93.  Review. PubMed PMID: 7791396.

Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S373-82. Review. PubMed  PMID: 17910560.

Communication Skills


McCulloch J, Ramesar S, Peterson H. Psychotherapy in primary care: the BATHE technique. Am Fam Physician. 1998 May 1;57(9):2131-4. Review. PubMed PMID: 9606304.

Quill TE, Townsend P. Bad news: delivery, dialogue, and dilemmas. Arch Intern  Med. 1991 Mar;151(3):463-8. PubMed PMID: 2001128.

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5(4):302-11. PubMed PMID: 10964998.

Campbell, T.C., Wood, G.J., Knight, C.F. (2008). Communication and the hospice and palliative physician’s role on the interdisciplinary team.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 2-95). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Delirium


Waszynski CM; Hartford Institute for Geriatric Nursing, Division of Nursing, New York University. Confusion Assessment Method (CAM). Medsurg Nurs. 2004 Aug;13(4):269-70. PubMed PMID: 15384483.

Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium?: value of bedside instruments. JAMA. 2010 Aug 18;304(7):779-86. doi: 10.1001/jama.2010.1182. Review. PubMed PMID: 20716741.

Holroyd-Leduc JM, Khandwala F, Sink KM. How can delirium best be prevented and managed in older patients in hospital? CMAJ. 2010 Mar 23;182(5):465-70. doi: 10.1503/cmaj.080519. Epub 2009 Aug 17. Review. PubMed PMID: 19687107; PubMed Central PMCID: PMC2842841.

Boustani, M.A., Buttar, A. (2008). Delirium.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 210-218). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Mittal V, Muralee S, Williamson D, McEnerney N, Thomas J, Cash M, Tampi RR. Review: delirium in the elderly: a comprehensive review. Am J Alzheimers Dis Other Demen. 2011 Mar;26(2):97-109. doi: 10.1177/1533317510397331. Epub 2011 Jan  31. Review. PubMed PMID: 21285047.

Dementia


Boustani, M.A., Ham, R.J. (2008). Alzheimer’s disease and other dementias.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 219-236). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Holsinger T, Deveau J, Boustani M, Williams JW Jr. Does this patient have dementia? JAMA. 2007 Jun 6;297(21):2391-404. Review. PubMed PMID: 17551132

Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med. 2011 Jun 9;364(23):2227-34. doi: 10.1056/NEJMcp0910237. Review. PubMed PMID: 21651394

Depression


Lammers, E.J. (2008). Alzheimer’s disease and other dementias.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 237-252). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Falls


Nanda, A., Sloane, B.D. (2008). Dizziness.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 263-278). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Stone, L.M., Sloane, P.D. (2008). Syncope.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 279-290). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Goldberg, A., Alexander, N.B. (2008). Gait and Mobility.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 253-262). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Schneider, D.C., Mader, S.L. (2008). Falls.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 291-305). Glenview, IL: American Academy of Hospice and Palliative Medicine. Functional Assessment

Fleming KC, Evans JM, Weber DC, Chutka DS. Practical functional assessment of elderly persons: a primary-care approach. Mayo Clin Proc. 1995 Sep;70(9):890-910. Review. PubMed PMID: 7643645.

Nutrition


Matthew, M.K., Funderburg, K. (2008). Malnutrition and feeding problems.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 361-370). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Bouras EP, Lange SM, Scolapio JS. Rational approach to patients with unintentional weight loss. Mayo Clin Proc. 2001 Sep;76(9):923-9. Review. PubMed PMID: 11560304.

Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med. 2006 Jan 3;144(1):37-48. Erratum in: Ann Intern Med. 2006 Apr 4;144(7):538. PubMed PMID: 16389253.

Finucane TE, Christmas C, Travis, K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999 Oct 13; 282(14):1365-1370.

Pain and Palliation


Potter J.F., Titman H.M. (2008). Persistent PAin.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 350-360). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Pressure Ulcers & Skin


Mash M.J., Fedor M., Bonnington L. (2008). Skin Problems.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 612-623). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Sezginsoy B., Wright J.E. (2008). Pressure Ulcers.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 371-384). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Transitions of Care


Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S285-92. Review. PubMed PMID: 17910549. Arora VM, McGory ML, Fung CH. Quality indicators for hospitalization and surgery in vulnerable elders. J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S347-58. Review. PubMed PMID: 17910557.

Miscellaneous


Neyhart, B. (2008). Osteoporosis.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 501-511). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, Phillips BA, Thorpy MJ, Vitiello MV, Zee PC. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 

Mouton C.P., Merkelz K.P., Espino D.V. (2008). Urinary tract infections.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 560-566). Glenview, IL: American Academy of Hospice and Palliative Medicine.

McGlory M.L., Ko C.Y (2008). Acute Abdomen.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 567-574). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Hornyak M, Trenkwalder C. Restless legs syndrome and periodic limb movement disorder in the elderly. J Psychosom Res. 2004 May;56(5):543-8. Review. PubMed PMID: 15172211.

Cefalu C.A. (2008). Urinary Incontinence.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 306-323). Glenview, IL: American Academy of Hospice and Palliative Medicine.

Rich MW. Office management of heart failure in the elderly. Am J Med. 2005 Apr;118(4):342-8. Review. PubMed PMID: 15808129.

Neyhart, B (2008). Osteoporosis.  In Storey, C. Porter, Levine S., Shega J.W (Eds.), Hospice and Palliative care training for physicians, a self-study program (pp. 501-511). Glenview, IL: American Academy of Hospice and Palliative Medicine.