Assessment In Geriatrics Flashcards
What is the role of the physiotherapist with older adults ?
1) Education of patients, family, and other health care professionals aiming to prevent and limit:
- impairments
- activity limitations
- participation restriction
2) Promoting prevention activities, health education and healthy lifestyle
3) Prescribing appropriate adaptive or assistive equipment, allowing the patient to perform functional tasks independently
4) assessment of living environment to minimize risks of falls
What are the main themes of subjective examination ?
ICF model:
- physical health
- mental health
- social factors
- environmental factors
Expectations of patient
What are the main themes of objective examination ?
- physical examination
- functional assessment
- falls risk assessment
- cognitive assessment
What is the main goal of physiotherapy in geriatrics ?
Maximum independence
What are the 5 domains of subjective examination ?
- physical health and nutritional status
- mental and emotional health
- function
- social context
- environmental context
What are the purposes of subjective examination ?
- collect subjective data from the patient
- corroborating or conflicting data from secondary sources to support or not info collect from patient (helps enrich history)
- obtain a sense of cognitive status
- gives clues, directions, for what to assess in the objective exam
List guidelines for the subjective Ax
- use a quite space with proper lightning
- talk randomly a few minutes to establish rapport
- avoid interrupting
- use active listening skills
- avoid medical terms
- build up relationship
What are the steps of the subjective Ax ?
- HOPC
- PMH
- physical/mental impairments
- nutritional status
- mobility
- ADLs
-IADLs - social history and support
- MEDs
History of presenting condition: give examples of questions
What brings you here ?
Have you experienced any fall ?
Have you experienced decreased function ?
Do you have any new, acute, complaint ?
Did a member of the family want a new assessment ?
(Does the person just needs someone to talk to?)
Past medical history : give examples of questions
What medical condition do you have ?
Any acute conditions ?
Any chronic conditions ?
Have you had any recent surgery ?
Give examples of common orthopedic chronic conditions in the older adult ?
Osteoporosis
fractures (femoral neck, humeral neck, wrist, vertebral)
Osteoarthritis
Rheumatoid arthritis
Give examples of common neurological chronic conditions in elderly
Cerebrovascular disease such as stroke or dementia
Neuropathy
Give examples of cardio respiratory common chronic conditions in elderly
Angina
Pneumonia
COPD
Hypertension
give examples of common metabolic chronic conditions in elderly
Diabetes
Obesity
Give examples of chronic psychological conditions in the older adult
Depression
Anxiety
Confusion
Dementia
Physical impairments: give exemple of questions to ask during subjective Ax
Do you wear glasses ?
When do you wear them ?
When was your last eye examination ?
Do you wear hearing aids ?
When was you last hearing test ?
Nutritional status : give examples of questions to ask during the subjective Ax
When was your last meal ?
What did you eat ?
What do you usually have for dinner ?
Mobility: give examples of question to ask during subjective Ax
Do you use walking aids ? Inside the house, outside the house, when you go to activities or appointments
How far can you walk at once, in a day ?
How do you manage stairs ?
Have you lost your balance in the last year ?
Have you had a near fall in the last year ?
Have you had a fall in the last year ?
How to evaluate function in older people ?
- through observation of the task performance
- through verbal report of the task performance
Give examples of ADLs
Bathing
Dressing
Toileting
Transfers
Grooming
Feeding
Give examples of instrumental activities of the daily living
Administering own medication
Grocery shopping
Preparing meals
(The first three being the most important ones)
Using the telephone
Driving and transportation
Handling own finances
Housekeeping
Laundry
What is the most appropriate tool to assess functional status ?
ADL-KATZ Questionnaire
What are the functions assessed by the ADL-KATZ Questionnaire ?
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
What is the strength of ADL-KATZ questionnaire
Can be administered by all the health care providers
What is the weakness of ADL-KATZ Questionnaire
It is not sensitive to small changes in function
What is the Barthel index ?
Ordinary scale used to measure performance in activities of the daily living including:
Feeding
Bathing
Grooming
Dressing
Bowels (continence)
Bladder (continence)
Toilet use
Transfer from bed to chair and back
Mobility on leveled surface
Stairs
Living environment : give examples of questions to ask during subjective Ax
How would you describe your life at home ?
Can you tell me what your typical day at home is like ?
Do you live in a house, appartement, assisted living place ?
Where is the bathroom ?
Do you have stairs to climb ?
Do you have any pets ?
Do you live alone ?
Is someone taking care of you ? Are you taking care of someone else ?
Social history: give examples of questions to ask during subjective Ax
- are / were you married ?
- do you have children ?
- what type of work did you do ?
- who lives with you at home ?
- where does your family live ?
- how often do people visit you at home ?
- how often do you go out and where ?
- do you have any difficulties with personal or domestic activities ?
- do you have any hobbies or sports you like to play ?
Why are older adults at risk of social isolation ?
Death of spouse
Family lives in another city/ country
Social circle gets smaller
Hearing impairment
Visual impairment
Medical issues
Decreased mobility
Why is social isolation and loneliness harmful to older people ?
They shorten older people’s lives
They damage their physical and mental health
They reduce their quality of life
Give an example of subjective assessment of cognitive impairments
Mini COG
Useful for early detection of dementia
Give examples of subjective Ax of depression
- Yale 1 question: “do you often feel sad or depressed ?
- two-question screening PRIME-MD PHQ tool: “During the past month, have you often been bothered by feeling down, depressed or hopeless”? ; “During the pas month, have you often been bothered by little interest or pleasure in doing things”?
- geriatric depression scale (15) items
Medication: give examples of questions for the subjective Ax
How many medications do you take ?
What do you take and when ?
How do you organize your medications ?
Medication: what are the key elements to be determined during subjective Ax ?
- Compliance
- symptom control
- drug interaction
=> Be aware of the fact that evaluation is influenced by cognitive state
What are the effects of poly pharmacy ?
Older adults taking more than 5 medications over 2 years have a 21% increase in rate of falls.
Older adults taking more than 10 medications over 2 years have a 50% increase in rate of fall.
What are the main aspects of the objective assessment ?
Assessment of the overall physical function, balance, strength and flexibility, including tests to assess mobility, joint ROM, muscle strength and balance.
Functional assessment in objective Ax: what categories, give examples of tests
- mobility
- gait
- stairs
- getting up of a chair
Tests:
- time up and go
- STS from a chair
Objective Ax/Falls risk: what are the main components ?
- evaluation of balance
- evaluation of gait
- ability to recover from a loss of balance
What is a comprehensive geriatric assessment .
A holistic assessment of a person’s health which focuses at physical function, mental function, ADLs, environmental factors, vision and hearing impairments, poly pharmacy.
Who needs a comprehensive geriatric assessment ?
Useful for anybody who experiences multiple health issues, have multiple diagnosis, take a lot of medications (to verify if there might be interactions ex: essential tremor is accentuated by medication against asthma). Anyone with complex health issue. Anyone who wants to optimize their function, quality of life.
What is involved in a comprehensive geriatric assessment and what is the goal ?
- Physical assessment
- Functional, social, and environmental assessment
- Psychological components
- Medication review
- what about day to day life
- what about your environment
- what are the hobbits
- how can we optimize this for the future (ex: live independently for longer)
- what adaptations can be done at home (ex: Alexia)
- how to optimize health on the long term (ex: home exercise)
- how to look after yourself to prevent deterioration of health condition
- promote independent living
Give examples of question and procedures in a comprehensive geriatric assessment
Holistic interview style
No physical examination
Subjective Ax
Aim at understand how to optimize independent living
What are the tools you can use during a comprehensive geriatric assessment
Depression questionnaire
MoCA
Is the comprehensive geriatric assessment a physiotherapy assessment ? Define it.
NO
It is a process/ framework to manage frail people including several steps
It involves a multidimensional and holistic assessment of an older person
The goal if to formulate a care plan, followed by interventions and regular reviews
What are the steps of the comprehensive geriatric assessment?
Assessment=> creation of problem list=> personalized care plan (evolving over time, helps with prioritizing and goals setting) => intervention => regular planned view.
When to do a comprehensive geriatric assessment ?
When the patient presents frailty syndromes
- falls
- confusion
- decreased mobility
Upon discharge
In care homes
What are the sings of frailty syndrome ?
- increased risk of falls
- incontinence
- decreased mobility
- confusion
Which tool assesses frailty ?
The Clinical Frailty Scale
If score is >5 then frailty is confirmed and the therapist must proceed with the comprehensive geriatric assessment
What are the benefits of comprehensive geriatric assessment ?
- reduced mortality rates
- improvement of independence for older people
- reduces hospital admission and réadmissions
- management strategy for frail older people
- frailty progression can be reversed
What are the components of the physical Ax in CGA ?
- sensory loss
- feet and footwear
- gait and balance (TUP, number of steps to turn around)
- lying and standing blood pressure (at 0, 1 and 3 min)
- cognition and mood (ex: can they follow simple commands? Any signs of drowsiness or hyper-vigilance?)
- functional ability
- pain in joints/ ROM
- weight and nutrition (tip: observe nails and hair)
- Rectal examination and genitalia (ex: constipation or incontinence)
- normal age related changes
CGA/Functional, social and environmental assessment : what are two basic components ?
- What can a person do and what they actually do
- How has it recently change
CGA/Functional impairment: what tools for measurement ?
- ADLs = Nottingham Extended ADL Scale
- Barthel index
- BGS social & environment questionnaires
- driving
- TUG
CGA/ Mood : what are the screening questions ?
- during the last month, have you often been bothered by feeling down, depressed or hopeless ?
- do you ever sit and cry for no reason ?
- do you worry about the future and what it might hold ?
- during the last month, have you often been bothered by having little interest or pleasure in doing things ?
- do you feel lonely ?
CGA/ Cognition : what is the simple screening question ?
Has the person been more forgetful in the 12 months to the extent it has affected their daily live ?
CGA/ Medications: core components
- full medication history
- review use of medication
CGA/ medication reviews: screening questions
- are you good at remembering your pills?
- can you swallow them correctly ?
- what are you most concerned about with your tablets?
For each medication:
- do you take this ?
- how often ?
- what for ?
- do you thing it works ?
- does it have any side effects ?
What is the CGA care plan focused on ?
Improvement of quality of life and coping.
What matters most for the patient.
What are the PT key roles in older adults rehab ?
Patient’s education and motivation
What is different in CGA compared to PT assessment ?
- connecting the patient with other clinicians is key in obtaining CGA
- multidimensional holistic assessment:
Multidisciplinary and interdisciplinary approach - greater depth regarding quality of life, functional status and outcome
