Assessment Flashcards
Features of a comprehensive geriatric assessment
Functional capacity Falls risk Cognition Mood Polypharmacy Social support Financial concerns Goals of care Advanced care preferences
Aim of a comprehensive geriatric assessment
Identify physical, socioeconomic, functional, mental, psychological and environmental issues
Formulate a mx plan accommodating patients own personal goals
Features of functional assessment
Generally done by occupational therapists
What can patient do and how has it changed
Link to what they need to be able to do in daily life
Features of falls assessment
Feet and footwear
- condition of feet indicates self care levels
- oedema and ulcers
- peripheral sensory testing
- warmth, pulses and peripheral oedema
- recommend well, fitting secure footwear
Gait and balance
- can patient walk, how far, do they need an aid
- any changes in walking, if so are they sudden
- restricted activity
- previous falls
- feel off balance, dizzy or unsteady
- functional ability - able to get up from chair, bed or toilet, able to climb stairs
- watch gait
- timed up and go test
- 180 turn test
- gait speed - less than 5 seconds to walk 4 metres
Pain/ joints
Lying/standing BP
- lie for 5 mins then check BP
- stand up and immediate check BP
- recheck 1 and 3 mins later
- drop of more than 20 or below 90 systolic shows postural hypotension
Sensory loss
- gross visual testing
- whisper number in ears
Weight and nutrition
- check and record weight
PR and genitalia
- constipation, prostate, haemorrhoids, bleeding or rectal masses
Pathological features of gait
Foot drop - peripheral neuropathy, nerve palsy
High stepping gait - mask foot drop
Trendelenburg gait - hip weakness
Parkinsonian signs - narrow base, freezing, festination, no arm swing, short shuffling gait
Ataxic gait - cerebellar issues, MSK injury
Flexed hip and knees - parkinson’s, MSK injury
Wide-based gait
Leaning too far forwards/backwards
Antalgic gait - weakness, pain
Features of social and environmental assessment
Who do they live with Nature of home circumstances Are the stairs - railing, chair lift Toilet facilities Bathroom - upstairs, bath, shower cubicle, wet room Equipment in situs Access to home Phone Cooking facilities Heating and lighting - damp concerns Smoke detector Personal alarm Current support How does patient get out and about - own vehicles, mobility scooter Is patient a carer Any pets Eligible for continuing health care funding Personal budget Receipt of any benefits Capacity concerns Safeguarding issues Power of attorney Will and funeral plans
Features of mood assessment
Observation of expression and affect
Psychomotor retardation, weight loss, poor sleep, increasing pain
Use geriatric depression score if indicated for a more formal assessment
Screening questions for depression
During the last month have you ever been bothered by feeling down, depressed or hopeless
Do you ever sit and cry for no reason
Do you every worry about the future
During the last month have you found little interest n the things you use to enjoy
Do you feel lonely
Features of cognition assessment
Involve family/carers - have they been more forgetful recently to the extent it’s affecting their daily life
Rate of decline - distinguish between delirium/dementia
Montreal Cognitive Assessment (MOCA)
Abbreviated mental test
Features of Montreal Cognitive Assessment
Trail making Immediate recall of words Fluency - name as many fruits as you can in minute Orientation - time, day, date, place Calculation Abstraction - what category to pear and banana belong to Delayed recall of earlier words Visuo-perception Naming - pictures of animals Attention
Features of abbreviated mental test
Age Time - to nearest hour Address to be recalled at end - 42 West Street What year is it Name of current location/institution Recognition of 2 people - name/job roles Date of birth - day and month Year of WWI Name of present monarch/prime minister Count backwards from 20 to 1
Features of medication review
Adverse effects of medication may outweigh benefits
Full medication hx - prescription summary from GP, dispensing hx from pharmacist, medications from other providers, herbal supplements, vitamins, illicit drugs
Review use - do you remember to take it, any problems, how often each drug take, what for, does it work, any side effects
Check for interactions
Check for appropriate mediation use
NO TEARS
- Need and indication
- Open questions - about patient’s adherence
- Tests and monitoring - current disease control
- Evidence and guidelines - have these changed
- Adverse events
- Risk reduction/prevention - falls
- Simplification and switches - several low dose agents with one full dose
