Assessment of elderly

Question 1

What are the most common causes of elderly fallers?

Answer 1

• Arrhythmias = ECG
• Postural Hypotension = Lying + standing BP
• Infections = urine dip, chest x-ray
• Medications = poly pharmacy increases risk of drug reactions and adverse effects

Talley and O’Connor Clinical Examination.

Question 2

What are the components of the geriatric assessment?

Answer 2

• Activities of daily living
• Balance / frailty test
• Cognition
• Depression, drugs (poly pharmacy), nutrition and weight change
• Environment - home situation, social support, financial issues, living will
• Falls risk (Hx of falls, functional reach test)
• Gait speed
• Hearing / vision
• Incontinence (Urine and stool), sexual function

Talley and O’Connor Clinical Examination.

Question 3

What are the risk factors for falls?

Answer 3

• Hx of multiple previous falls
• > 80 y/o
• Difficulty in getting up from chair
• Use of walking stick / frame
• Arthritis
• Poor vision
• Cognitive decline / depression
• Muscle weakness
• Parkinsons disease
• Gait / balance problems e.g. stroke
• Mechanical problems in house e.g. loose rugs
• Drug treatment (poly pharmacy, sedatives, antidepressants, anti hypertensives, anticholinergics)

Talley and O’Connor Clinical Examination.

Question 4

What are the components of the instrumental activities of daily living (IADL) scale?

Answer 4

1. ability to use phone
2. shopping
3. food prep
4. housekeeping
5. laundry
6. transport
7. medications management
8. ability to handle finances

score 1 for each
0 = total dependence
8 = total independence

Talley and O’Connor Clinical Examination.

Question 5

What are the components of index of activities of daily living (ADLs)?

Answer 5

1. bathing
2. dressing
3. toileting
4. transferring
5. continence
6. feeding

1 point for everyone that can be done independently

6= fully functional
4 = moderately impaired
2 = severely impaired

Talley and O’Connor Clinical Examination.

Question 6

What are the risk factors for urinary incontinence in elderly

Answer 6

• obesity
• parity (having had children)
• gynaecological surgery
• diabetes
• smoking
• diuretic drugs
• immobility
• recurrent UTIs
• previous radial prostatectomy (removal of prostate gland|)
• cognitive impairment
• Immobility

Talley and O’Connor Clinical Examination.

Question 7

What are the risk factors for pressure sores?

Answer 7

• Cognitive impairment
• Immobility
• advanced age
• sensory impairment
• low body weight
• oedema
• incontinence
• hypoalbuminaemia

Talley and O’Connor Clinical Examination.

Question 8

How do you classify bed sores?

Answer 8

I = skin intact, non-blanching erythema
II = partial thickness loss of skin. shallow open ulcer no blister
III = full thickness loss of tissue. subcutaneous fat visible but not bone or muscle
IV = Full thickness but base covered in slough
Suspected deep tissue injury = purple or maroon coloured area of intact skin or a blood filled blister

Talley and O’Connor Clinical Examination.