3 - Geriatric Assessment Flashcards
What is geriatric syndrome?
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
How are geriatric syndrome Id’d?
Via complete geriatric assessment
What is a geriatric assessment?
Clinical approach to the elderly pt that goes beyond traditional H/P
Must include
- functional
- social
- psychological domains
That affect well being and QOL
Key concepts for geriatric assessment?
Teams and clinical sites of care
Prognosis
Pt goals
Functional status
Examples of interprofessional and integrated clinical sites of care?
In patient units
Rehab units
PACE (program for all-inclusive care of elderly)
Long term care facilities
Prognosis considerations?
Life expectancy >/< 10 yrs
Palliative care if <18 mo
Hospice care < 6 mo
Life tables and calculations?
Disease specific instruments
- ePrognosis
What good is functional status?
Needed for planning, monitoring response to therapy and determining prognosis
Require assistance for ADL and IADL:
- 25% >65
- 50% > 85
Tools/templates for determining functional status?
Simple geriatric screening tool (text book)
VES-13
Katz index for ADL
Lawton scale for IADL
Examples on 9-13
Functional assessment can provide information that may be used to:
- Monitor future declines
- Determine need for support services or placement
- Determine need for med/surg intervention
- Determine need for rehab therapies
ADL decline indicates?
Worsening of specific disease process(es)
And/or
Combined impact of multiple comorbids
- typically occurs when diseases are in advanced stages
New or subtle decline in IADL function may indicate?
- presence of disease
- loss of vision/hearing
- fear of falling
- depression/dementia
Get them supportive services
If a highly funcitonal elder begins to drop activity consider?
Early functional impairment
Or
Onset of depression/dementia
Leading cause of nonfatal injuries and unintentional inj/death in elderly?
Falls
____ often contributes to falling?
Gait impairment
- eval every visit
Gait and balance assessment is a sensitive method for detecting?
- Arthritis
- Muscle weakness
- Neurological impairments
- Components of standard neuro exam
Gait tests?
Get up and go test
- strength, gait, balance, judgment
Timed get up and go test
- slowed performance = ADL impairment
Vision screening?
Use a
- snellen eye chart (near)
- Jaeger card (far)
Optometrist exams
- esp for DM/glaucoma pts
In office hearing test?
Whispered voice test
- sensitivitty 70%
- specificity 100%
HHIE-S test?
Hearing handicap inventory for elderly screening
Questionnaire, >10 get a hearing test
Two widely used dementia screening tests?
Mini-mental state exam
- takes 10 min
Mini-cog exam
- quick
- 3 item recall + clock drawing
Elderly and depression?
No higher incidence but they are more likely to have symptoms
screening for depression?
PHQ-2
- Over the past 2 weeks have you felt down, depressed or hopeless?
- Over past 2 weeks have you felt little interest or pleasure in doing things?
Most elderly wont tell you about ___ unless you ask?
Incontinence
- though its common among elderly
