3 - Geriatric Assessment

Question 1

What is geriatric syndrome?

Answer 1

Conditions in older adults that do not fit into distinct categories

• multifactorial causes
• lead to disability and decreased QOL

I.e.

• cognitive impairment
• delirium
• gait d/o
• pressure ulcers
• sleep d/o
• sensory deficits
• fatigue
• dizziness

Question 2

How are geriatric syndrome Id’d?

Answer 2

Via complete geriatric assessment

Question 3

What is a geriatric assessment?

Answer 3

Clinical approach to the elderly pt that goes beyond traditional H/P

Must include

• functional
• social
• psychological domains

That affect well being and QOL

Question 4

Key concepts for geriatric assessment?

Answer 4

Teams and clinical sites of care
Prognosis
Pt goals
Functional status

Question 5

Examples of interprofessional and integrated clinical sites of care?

Answer 5

In patient units
Rehab units
PACE (program for all-inclusive care of elderly)
Long term care facilities

Question 6

Prognosis considerations?

Answer 6

Life expectancy >/< 10 yrs
Palliative care if <18 mo
Hospice care < 6 mo

Question 7

Life tables and calculations?

Answer 7

Disease specific instruments

- ePrognosis

Question 8

What good is functional status?

Answer 8

Needed for planning, monitoring response to therapy and determining prognosis

Require assistance for ADL and IADL:

• 25% >65
• 50% > 85

Question 9

Tools/templates for determining functional status?

Answer 9

Simple geriatric screening tool (text book)
VES-13
Katz index for ADL
Lawton scale for IADL

Examples on 9-13

Question 10

Functional assessment can provide information that may be used to:

Answer 10

• Monitor future declines
• Determine need for support services or placement
• Determine need for med/surg intervention
• Determine need for rehab therapies

Question 11

ADL decline indicates?

Answer 11

Worsening of specific disease process(es)
And/or
Combined impact of multiple comorbids
- typically occurs when diseases are in advanced stages

Question 12

New or subtle decline in IADL function may indicate?

Answer 12

• presence of disease
• loss of vision/hearing
• fear of falling
• depression/dementia

Get them supportive services

Question 13

If a highly funcitonal elder begins to drop activity consider?

Answer 13

Early functional impairment
Or
Onset of depression/dementia

Question 14

Leading cause of nonfatal injuries and unintentional inj/death in elderly?

Answer 14

Falls

Question 15

____ often contributes to falling?

Answer 15

Gait impairment

- eval every visit

Question 16

Gait and balance assessment is a sensitive method for detecting?

Answer 16

• Arthritis
• Muscle weakness
• Neurological impairments
• Components of standard neuro exam

Question 17

Gait tests?

Answer 17

Get up and go test
- strength, gait, balance, judgment

Timed get up and go test
- slowed performance = ADL impairment

Question 18

Vision screening?

Answer 18

Use a

• snellen eye chart (near)
• Jaeger card (far)

Optometrist exams
- esp for DM/glaucoma pts

Question 19

In office hearing test?

Answer 19

Whispered voice test

• sensitivitty 70%
• specificity 100%

Question 20

HHIE-S test?

Answer 20

Hearing handicap inventory for elderly screening

Questionnaire, >10 get a hearing test

Question 21

Two widely used dementia screening tests?

Answer 21

Mini-mental state exam
- takes 10 min

Mini-cog exam

• quick
• 3 item recall + clock drawing

Question 22

Elderly and depression?

Answer 22

No higher incidence but they are more likely to have symptoms

Question 23

screening for depression?

Answer 23

PHQ-2

1. Over the past 2 weeks have you felt down, depressed or hopeless?
2. Over past 2 weeks have you felt little interest or pleasure in doing things?

Question 24

Most elderly wont tell you about ___ unless you ask?

Answer 24

Incontinence

- though its common among elderly

Question 25

Nutrition screening?

Answer 25

Height, weight, BMI, loss of muscle mass

- unintentional wt loss >5% needs eval

Question 26

Abuse/ neglect screening?

Answer 26

Ask directly, look for warning signs

Question 27

Immunizations for the elderly

?

Answer 27

Influenza - annually
Pneumocococcal (65+)
Td and Tdap q 10 yrs
Herpes zoster age 60 (once)

Question 28

What did the ocean say to the sailboat?

Answer 28

Nothing, it just waived