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BPT 17 - Geriatric > 3 - GERIATRIC PT ASSESSMENT > Flashcards

3 - GERIATRIC PT ASSESSMENT Flashcards

1
Q

Roles of PT with older adults

A

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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2
Q

Subjective examination

A
  • 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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3
Q

Objective examination

A
  • Physical examination
  • Functional assessment
  • Falls risk assessment
  • Cognitive assessment
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4
Q

Multidisciplinary assessment

A
  • Necessary to involve professional from variety of specialties
  • Oriented to skills & capabilities necessary for maximum independence
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5
Q

ICF model

A

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

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6
Q

Purpose of subjective assessment

A

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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7
Q

Tips for subjective assessment

A
  • 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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8
Q

Components of subjective assessment

A
  • HOPC
  • PMC
  • Physical / mental impairments
  • Nutrition
  • Mobility
  • ADLs
  • IADLs
  • Social history / social support
  • MEDS
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9
Q

History of presenting condition

A
  • What’s happen?
  • Loss of function?
  • New or acute complaint?
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10
Q

Past medical history & chronic conditions in older adult

A
  • 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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11
Q

Physical & mental impairments

A

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

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12
Q

Nutrition

A

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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13
Q

Mobility

A
  • Use of walking aids?
  • How far can u walk at once? In a day?
  • Have u had fall..?
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14
Q

ADLs

A

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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15
Q

Methods of assessment

A

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

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16
Q

ADLs & IADLs

A

Tableau

17
Q

Names of 2 questionnaires of ADLs

A

Katz questionnaire
Barthel index

18
Q

Katz questionnaire

A

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

19
Q

Barthel index

A
  • 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
20
Q

Living environment

A
  • House or appartement
  • Stairs
  • Pets
  • Live alone or with anyone
21
Q

Social history

A
  • Children
  • Friends
  • Sport
  • Activities
  • Work
  • Family
  • Clubs

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

22
Q

Social isolation & loneliness in older adults

A
  • Risk of loneliness & social isolation
  • Family lives in another country? Death of spouse? Hearing impairment? Medical issues? Loss of mobility …
23
Q

Cognition impairment: assessment

A

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

24
Q

Depression assessment

A
  • Yale 1 question: do u often feel sad or depressed?
  • 2-question screening tool (prime-MD PHQ)
  • Geriatric depression scale
25
Q

Medication

A
  • How many?
  • Which one ?
  • When?
26
Q

Physical examination

A
  • Assessment overall physical function, balance, strength & flexibility
  • Include tests to assess mobility, joint range of motion, muscle strength & balance
  • Sensory deficiencies
27
Q

Functional assessment

A
  • Mobility & gait
  • Activities of ADLs
  • Stairs Ax
  • Getting up from chair
    Examples: timed up & go; sit to stand from chair
28
Q

Fall risk assessment

A
  • Very important
  • Evaluation of balance / gait, ability to recover from loss of balance
29
Q

Comprehensive geriatric assessment: description & when do it?

A
  • 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

30
Q

Frailty syndrome: description, when do it?

A
  • 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

31
Q

Benefits for frail population

A
  • 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
32
Q

Sarcopenia outcome measures

A
  • 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)
33
Q

Outcomes mobility / ADLs

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

BPT 17 - Geriatric (11 decks)

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