Clinical medicine rotations
Geriatric medicine & palliative care
Geriatric medicine is the care of older adults with multiple illnesses; palliative care supports people with life-limiting illness to live and die well. Both connect strongly with psychiatry through dementia, delirium, depression in later life, grief and end-of-life decisions.
Depth by stage, Pre-U → Consultant (details)
What is it?
Geriatric medicine focuses on frail older people with several conditions at once, falls, incontinence, memory problems and many medicines. Palliative care focuses on comfort, symptom control and support for people with serious illness and their families.
Students learn comprehensive geriatric assessment, medication review, advance care planning and how to talk about death. Malaysia's population is ageing, so these skills are increasingly important.
Psychiatry overlaps heavily: older people are vulnerable to delirium, dementia and depression, and patients near the end of life often have anxiety, depression or demoralisation.
Why does a psychiatrist need it?
Old age psychiatry is a major subspecialty, and general psychiatrists see older patients regularly. Polypharmacy, delirium, capacity to make decisions, carer stress and grief are everyday issues. Palliative care teams also ask psychiatrists for help with depression and requests to hasten death.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns ageing physiology and ethics of end-of-life care.
- ClinicalUnderstandsPerforms geriatric assessments and observes palliative care.
- HousemanshipUnderstandsCares for many older patients on medical wards.
- Medical officerUnderstandsManages older adults with multiple conditions.
- Psych traineeAppliesApplies this in old age psychiatry and liaison rotations.
- Specialist / consultantAppliesLeads complex decisions on capacity, end-of-life care and dementia services; old age subspecialists reach mastery.
What are the key topics?
Geriatric medicine
- Comprehensive geriatric assessment
- Frailty and falls
- Polypharmacy and medication review
- Incontinence and pressure injuries
- Cognitive screening
Palliative care
- Pain and symptom control
- Breaking bad news
- Advance care planning
- Care in the last days of life
- Support for families
Links to psychiatry
- Delirium
- Dementia and behavioural symptoms
- Depression in later life
- Capacity assessment
- Grief and prolonged grief
- Psychological distress in terminal illness
Ethics
- Best-interest decisions
- Withholding and withdrawing treatment
- Cultural and religious views on death in Malaysia
How is it learned and assessed?
- Ward and palliative care unit attachments
- Case-based learning and reflective writing
- OSCE stations on communication
- Assessed within medicine or community postings
Typical textbooks and resources
- Oxford Handbook of Geriatric Medicine — practical reference
- Oxford Handbook of Palliative Care — practical reference
- Brocklehurst's Textbook of Geriatric Medicine — comprehensive text
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Why do psychiatrists see older patients?
Older people often experience dementia, delirium and depression. Psychiatrists help diagnose and manage these, assess decision-making capacity and support families.
Do psychiatrists work in palliative care?
They support palliative care teams with depression, anxiety, delirium and complex distress near the end of life, especially in larger hospitals.