- Use of walking aids? - How far can u walk at once? In a day? - Have u had fall..?

3 - GERIATRIC PT ASSESSMENT Flashcards by Ernestine Fayon

Roles of PT with older adults

1) Education of patients, family & other health care professionals aiming to prevent & limit:
- Impairments
- Activity limitations
- Participation restriction

2) Promoting prevention activities, health education & healthy lifestyle

3) Prescribing appropriate adaptive or assistive equipment, allowing patient to perform functional tasks independently
4) Assessment of living environment minimize risks of falls

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Subjective examination

Physical health & nutritional status: OA, urinary incontinence..
Mental & emotional health: depression, cognition
Function: unable to shower
Social: lives alone
Environmental: stairs to bedroom

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Objective examination

Physical examination
Functional assessment
Falls risk assessment
Cognitive assessment

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Multidisciplinary assessment

Necessary to involve professional from variety of specialties
Oriented to skills & capabilities necessary for maximum independence

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ICF model

ICF model: physical health, mental health, social factors & environment

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Purpose of subjective assessment

1) Collect subjective data from patient
2) Corroborating or conflicting data from secondary sources (family..) may support (or not) info collected from patient, helps to enrich history
3) Obtain sense of cognitive stats (mild cognitive impairment, fear & denial - no complaints, depression)
4) Give clues / direction for what to assess in objective exam

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Tips for subjective assessment

Use quiet space with adequate lighting when possible
Talk few minutes to establish rapport, avoid interrupting, use active listening skills, avoid medical terms, be careful with language you use
—> Build up / strengthen relationship with provider (older adult)

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Components of subjective assessment

HOPC
PMC
Physical / mental impairments
Nutrition
Mobility
ADLs
IADLs
Social history / social support
MEDS

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History of presenting condition

What’s happen?
Loss of function?
New or acute complaint?

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Past medical history & chronic conditions in older adult

Acute or chronic condition?
Recent surgery?
Orthopaedic: osteoporosis, fracture
Neurological: cerebrovascular disease (stroke, dementia), neuropathy
Cardiorespiratory: angina, pneumonia, COPD, hypertension
Metabolic: diabetes, obesity
Psychological: depression, anxiety, confusion, dementia

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Physical & mental impairments

Vision & hearing
- Wear glasses?
- When was last eye examination?
- Wear hearing aids?

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Nutrition

Aging causes loss of muscle mass & resistance to building muscle mass
- Sedentary lifestyle + low protein diet = important loss of muscle mass
- Older adults require exercise (resistance training) & protein to counter muscle mass loss
- Older adults require 35% of calories to be protein. Protein at every meal!
- Protein - adults 0,8 g/kg body weight
- > 50 y.o: 1,0-1,2 g/kg body weight

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Mobility

Use of walking aids?
How far can u walk at once? In a day?
Have u had fall..?

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ADLs

Evaluation of function
Normal aging changes & health problems often reflected in declines in physical abilities (function) of elderly, which can result in decreased independence & decreased safety

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Methods of assessment

1) Observation of task performance
2) Verbal report of task performance

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ADLs & IADLs

Tableau

Names of 2 questionnaires of ADLs

Katz questionnaire
Barthel index

Katz questionnaire

Most appropriate tool to assess functional status by measuring patient’s ability to perform activities of daily living independently
- Assesses 6 functions: bathing, dressing, toileting, transferring, continence & feeding
- Score 1 or 0 per question
- Total score out of 6
- Results: full function 6 / moderate function 4 / severe impairment < 2

Strength: can be administered by many allied health in 10min
Weakness: not sensitive to small changes in function

Barthel index

Evaluate feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfer (bed to chair & back), mobility & stairs
Score between 0 & 10, except bathing, grooming (0-5) & transfers, mobility (0-15)
Total: 100
Result: 0 = unable, 5 = need help, 10 = minor help, 15 = independent

Living environment

House or appartement
Stairs
Pets
Live alone or with anyone

Social history

Children
Friends
Sport
Activities
Work
Family
Clubs

—> Explore past: married? Children? Work? ..
—> Present: who lives here? People visit you? Hobbies? Difficulties?..

Social isolation & loneliness in older adults

Risk of loneliness & social isolation
Family lives in another country? Death of spouse? Hearing impairment? Medical issues? Loss of mobility …

Cognition impairment: assessment

Mini cog: quick test, 3 min, early detection of dementia

Depression assessment

Yale 1 question: do u often feel sad or depressed?
2-question screening tool (prime-MD PHQ)
Geriatric depression scale

Medication

- How many? - Which one ? - When?

Physical examination

- Assessment overall physical function, balance, strength & flexibility - Include tests to assess mobility, joint range of motion, muscle strength & balance - Sensory deficiencies

Functional assessment

- Mobility & gait - Activities of ADLs - Stairs Ax - Getting up from chair Examples: timed up & go; sit to stand from chair

Fall risk assessment

- Very important - Evaluation of balance / gait, ability to recover from loss of balance

Comprehensive geriatric assessment: description & when do it?

- CGA ≠ typical medical review or standard PT assessment - Process / framework to manage frail people including several steps - Involves multidimensional & holistic assessment of older person —> Formulation of care plan, followed by interventions & regular reviews When do it? When patient presents with frailty syndromes - GP visit & patient presents with falls, confusion, decreased mobility - Patient’s incidence which implies frailty (calling ambulance after fall) - Upon hospital discharge - In care homes

Frailty syndrome: description, when do it?

- Term used to denote multidimensional syndrome loss of reserves (energy, physical biliary, cognition, health) that gives rise to vulnerability - Consists of 5 main criteria: weakness, slowness, low level of physical activity, self-reported exhaustion & unintentional weight loss > 5 kg/year When do it? When patient has signs of. Fragility syndrome (increased risk of falls, incontinence, decreased mobility, confusion) - Clinical Frailty scale: score > 5 requires CGA - Person with score > or equal to 5 considered frail Role as physio develops & keeps expanding Results 1) Very fit 2) Well 3) Managing well 4) Vulnerable 5) Mildly frail 6) Moderate frail 7) Severe frail 8) Very severe frail 9) Terminally frail

Benefits for frail population

- Reduced mortality rates - Improvement of independence for older people - Reduces hospital admissions & readmissions - Management strategy for frail older people - Frailty progression can be reversed with CGA

Sarcopenia outcome measures

- SARC-F ( strength, ambulation, rising from chair, stair climbing, history of falling) - MSRA (mini sarcopenia risk assessment) - Grip strength - Chair stand test - 30 sec - 4 stage balance test - TUG test - Gait speed test (GST-4)

Outcomes mobility / ADLs

- Nottingham Extended ADL scale - Barthel index - Bristol ADL scale - BGS social & environment questionnaires driving