Teaching Strategies for Atypical Presentation of Illness in Older Adults

Abstract

Atypical presentation of illness is a phenomenon where "seeing is believing." Expert geriatric nurses and clinicians know all too well the early signs and symptoms of this phenomenon, which frequently masquerades bacterial infections, pain, acute myocardial infarction, heart failure, or other serious medical ailments in older adults. Students, however, as novices to clinical practice, require interactive learning approaches to reflect on the patient's illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and witness resolution of an atypical presentation when found and treated. Use of a case study as an educational tool can facilitate critical thinking about a clinical problem, such as atypical presentation of illness, for students within a problem-based learning format. Furthermore, we highlight strategies for teaching students atypical presentation of illness with consideration of student learning preferences, which include visual, auditory, reading, and kinesthetic modes of learning.

A framework for delivering nursing care to older adults with COVID‐19 in nursing homes

“…Challenges to the detection of Infection in NH residents and altered physiology Signs of infection, such as fever in response to a bacterial infection, may be absent or altered, atypically presenting, aging structural and functional changes in the lung result in increased risk for pneumonia (Esme et al, 2019;Gray-Miceli et al, 2012;Meyer, 2005). Experts have found a dysregulation of the immune and inflammatory systems, most of which is associated with changes in T cell-mediated immunity, contributing to increase incidence of infectious diseases (Meydani, 2010).…”

“…physiological changes cause atypical presentation of illness (Esme et al, 2019;Gray-Miceli et al, 2012; refer to Table 1) making infections difficult to detect. A dysregulation of the immune and inflammatory systems also increases incidence of infectious diseases (Meydani, 2010;refer to (Bruggencate et al, 2018;McMaster Optimal Aging Portal, 2018).…”

“…Signs of infection, such as fever in response to a bacterial infection, may be absent or altered, atypically presenting, aging structural and functional changes in the lung result in increased risk for pneumonia (Esme et al., 2019; Gray‐Miceli et al., 2012; Meyer, 2005).…”

“…NH residents are prone to nosocomial infections not only because of their advanced age, co‐morbidities, disabilities, and frailty superimposed on age‐related physiological changes in lung structure and function (Meyer, 2005), but also because of the close proximity in which they share space, allowing airborne pathogens to spread. Additionally, age‐related physiological changes cause atypical presentation of illness (Esme et al., 2019; Gray‐Miceli et al., 2012; refer to Table 1) making infections difficult to detect. A dysregulation of the immune and inflammatory systems also increases incidence of infectious diseases (Meydani, 2010; refer to Table 1).…”

An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study

“…Butter et al [ 27 ] have demonstrated transfer of skills and knowledge learnt through simulation training to the clinical environment. Learners having undergone simulation training accurately assessed 93.8% of simulated heart sounds ( P <.001) compared with 73.9% accuracy among untrained students [ 28 ]. The authors subsequently advocate for simulation-based mastery learning programs, contending that they are a practice and feasible modality, allowing sufficient time for practice and compliant with competency-based accreditation requirements [ 28 ].…”