Assessments & the Elderly Flashcards
Outline a Comprehensive Geriatric Assessment
o Physical = gait, hearing, visual, balance, skin, oedema, ulcers, vibrations, joint position, light touch, perfusion, pulses, CRT, timed-up-and-go, orthostatic BP, alertness (4AT), weight/nutrition, PR, external genitalia
o Socioeconomic = social assessment, environmental questionnaire
o Functional = mobility (gait, balance, strength), interaction with technologies, how recently has the situation changed, Barthel index (performance of ADL), Nottingham Extended ADL Scale, timed-up-and-go
o Mental/psychological = mood (geriatric depression score), cognition (GP-Cog)
o Environmental domains = medication review (NO TEARS tool, STOP-START, MAI)
How can walking and balance be assessed?
- Timed-up-and-go = sit in knee height chair, stand up, walk 3m, turn around, return to chair, sit down (>12s is impaired)
- 180 degree turn test = sit in chair (boxed in), stand up (you stand behind), turn to face you, count steps (>5 higher risk of falling)
- Gait speed = walk 4m (>5s is slow)
- Chair stand = sit in chair at knee height, stand (use of arms, likely to have lower limb strength impairment)
What abnormalities should you be looking for when assessing gait?
Foot drop (peripheral neuropathy, nerve palsy, damage from previous CVAs)
High stepping gait / heavy foot placement (possible foot drop)
Trendelenburg(waddling) gait (hip weakness due to specific musculoskeletal problems around the hip)
Parkinsonian signs (narrow base, freezing, festination, loss of arm swing)
Ataxic gait (cerebellar issues, MSA)
Flexed hips and knees (PD, lower extremity MSK deficits resulting in muscle weakness or tightness)
Wide-based gait
Leaning too far forwards or backwards
Short steps / shuffling gait (PD, cerebrovascular disease)
Antalgic gait (less time spent in stance phase on one leg – usually due to weakness or pain)
Circumduction of one leg in walking
How should mood be assessed in the elderly population?
Geriatric Depression Scale (GDS) = 30-item, self-report instrument that uses a “Yes/No” format
Name the tests used for cognitive assessment
GP-Cog = >8 or <5 on the patient section are cognitively intact or impaired, respectively. On the informant questionnaire, <3/6 indicates cognitive impairment.
Abbreviated Mental Test Score (AMTS) = <6 suggests delirium or dementia
Mini Mental State Assessment (Folstein) = 25-30 normal,21-24 mild, 10-20 moderate, <10 severe impairment
Montreal Cognitive Assessment (MOCA) = >26 normal. In a study, people without cognitive impairment scored an average of 27.4; people with mild cognitive impairment (MCI) scored an average of 22.1; people with Alzheimer’s disease scored an average of 16.2
Six Item Cognitive Impairment Test (6 CIT) = dementia screening
What tests are used when investigating suspected delirium?
Confusion Assessment Method (CAM) = assessment for delirium
The 4A Test (4AT) = assessment of delirium
- alertness
- attention
- acute change
- AMT4 (age, DoB, place, year)
What tools can be used when performing a medication review?
NO TEARS tool = need and indication, open questions, tests and monitoring, evidence and guidelines, adverse events, risk reduction or prevention, simplification and switches
STOP-START = series of rules/suggestions
Medication Appropriateness Index (MAI) = individually and in combination with other medicines, whether the cost:benefit decision to prescribe the medication in question is appropriate
How should fracture risk be assessed?
FRAX tool = risk factors in addition to DXA measurements for improved fracture risk estimation
DEXA scan = x-ray measuring bone density
Ca + Vit D levels = levels measured via b/t
Outline the assessment of frailty
Clinical Frailty Score (CFS) = 1-9 score
Electronic Frailty Index (eFI) = uses red codes embedded within records to compute a score
How should stroke be assessed?
National Institutes of Health Stroke Scale (NIHSS) = evaluate neurological status in acute stroke
Recognition of Stroke in the Emergency Room (ROSIER) = differentiate stroke and “stroke mimics”
What is the Berg Balance Scale?
Scale to determine a patient’s ability (or inability) to safely balance during a series of predetermined tasks.
It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function
A score of 56 indicates functional balance.
A score of < 45 indicates individuals may be at greater risk of falling.
How is capacity assessed?
2 stages
1) any impairment of mind/brain, whether as a result of illness/alcohol/drugs
2) does the impairment mean the person is unable to make a specific decision
MCA says you cant make a decision if = cant understand info, cant retain info, cant use/weight up info as part of making decision
What factors are looked at in a mental state examination?
Appearance and behaviour Speech Mood Thought Perception Cognition Insight
Which medications in the geriatric population need to be stop gradually?
Antipsychotics, PD, pregabalin, PPIs (or switch to ranitidine)
A 78y has scored 20/30 in her MMSE, is this pt at high risk of falls?
False – 10-20 is moderate Alzheimer’s, yet to lose perception of risk
