Comprehensive Geriatric Assessment Flashcards
Goal of comprehensive geriatric assessment?
maximize overall health w/aging
Who should receive a comprehensive geriatric assessment?
elderly pt’s w/ heart failure or CA, psychosocial disorders, isolation, dementia, falls, prior/predicted high health care utilization, change in living situation
exclude: pt’s too well or too sick to benefit
What are 2 things that are NOT inevitable consequences of aging?
decline in fx and loss of independence
Similarities and differences from standard medical eval?
Incorporates all facets of a conventional medical history
Includes non-medical domains
Emphasis on functional capacity and quality of life
multidisciplinary team
What is included in a structured multidimensional approach?
- functional capacity
- physical health (pharmacy)
- cognition/mental health
- socio-environmental
What is functional capacity?
person’s ability to perform tasks that are required for living.
What can signal the need for more in-depth eval’s of the pt’s socio-environmental circumstances and need for adtn’l assistance
Deficits in Basic Activities of daily living (ADL)
and
Instrumental activities of daily living (IADL )
Examples of Basic ADL’s
self-care activities that a person performs daily
Eating, dressing, bathing, grooming, transferring to bed/chairs, using toilet, controlling bladder and bowel fx’s
What tool can you use to assess ADL’s?
Katz Index of independence
Examples of IADL’s:
activities needed to live independently
housework, meal prep, taking meds properly, managing finances, telephone use
What tool can you use to assess IADL’s?
Lawton instrumental activities questionnaire
what are 5 specific topics related to physical health?
- Nutrition
- Vision/hearing
- Fecal and urinary continence
- Balance and fall prevention, osteoporosis
- Polypharmacy
What are some concerning vital signs?
BP - HTN or orthostatic hypotension
HR - brady or afib
RR - >25
temp - hyper/hypothermia
what signs are you looking for on a cardiac exam?
S4
systolic ejection
regurgitant murmurs
what signs are you looking for on a pulmonary exam/breast exam?
barrel chest, SOB, masses
what signs are you looking for on abdomen, GI, genital/rectal exam?
pulsatile mass, atropy of vaginal mucosa, constipation, fecal incontinence, prostate enlargement/nodules, rectal mass, occult blood, urinary incontinence
what signs are you looking for on extremity exam?
abnormalities of the feet, diminished or absent lower extremity pulses, heberden nodes
what signs are you looking for on muscular/skeletal exam?
diminished ROM, pain, dorsal kyphosis, vertebral TTP, back pain, gait disturbances, leg pain, muscle wasting, proximal muscle pain or weakness
what signs are you looking for on skin exam?
erythema, ulceration over pressure points, unexplained bruises, premalignant lesions
Which vitamins are often deficient in elderly?
vitamins A, C, D, and B12 calcium
iron
zinc
4 components specific to geriatric nutrition assessment?
- nutritional health checklist for nutrition hx
- 24hr dietary recall
- PE for s/s assoc. w/inadequate nutrition or overconsumption
- select lab tests
Low vision is assoc. w/
increased risk of falls, decline in cognition, and increased rates of depression
what are some common causes of vision impairment?
presbyopia, glaucoma, diabetic retinopathy, cataracts, and ARMD (age-related macular degeneration)
Who should vision assessments be performed on?
adults with recent cognitive decline, functional impairment, or falls
hearing loss is assoc. w/…
depression, social isolation, poor self-esteem, increased hospitalization rates, cognitive decline, and functional disability
who should you screen for hearing loss and how?
adults over 65
asses w/ surveys, whisper voice test and audiometry
What questionnaire can you use to assess hearing loss?
hearing handicap inventory for the elderly
what is one potential cause of hearing loss?
ototoxic drugs
who should you refer to if having hearing loss?
Otolaryngologist
TOC for hearing loss?
hearing aids
urinary incontinence complications?
decubitus ulcers, sepsis, renal failure, urinary tract infections, and increased mortality
what major decision do you have to consider if elderly pt is having urinary incontinence?
nursing home placement
what should you look for on PE for incontinence?
evaluate fluid overload
neurologic function
mobility
what diagnostic tool can you use to assess balance and fall prevention?
tinetti balance and gait evaluation: get up from chair, walk 10 ft, turn around and come back
how can older persons decr their fall risk?
exercise, PT, home hazard assessment, withdrawal of psychotropic meds
osteoporosis may result in…
low impact or spontaneous fx’s
how does the USPSTF recommend screening of women 65+ y/o for osteoporosis?
DEXA of the femoral neck
which tool can helps with medication assessment to reduce adverse effects?
Beers criteria (list of meds inapprop. for elderly)
what are some atypical sxs that older pt’s w/depression present w/?
somatic complaints, cognitive, functional problems, sleep problems, fatigue
What 2 Q’s should you use to eval depression in elderly?
- during past mo. have you been bothered by feeling down, depressed, or hopeless?
- during past mo. have you been bothered by little interest or pleasure in doing things?
what is the next step if positive screen for depression w/2 Q’s screener?
7 additional questions to complete PHQ-9
What does an eval of dementia include?
thorough history brief cognition screens detailed mental status exam neuropsychologic testing labs (Vitamin B12, TSH) depression assessment radiographic imaging
what is the most widely used cognitive test for dementia?
MMSE (mini mental status exam)
how do you perform mini-cognitive assessment?
step 1 –> repeat 3 unrelated words
step 2 –> pt draw clock set to 11:10
step 3 –> recall 3 words from step 1
what does a brief screen of socioenvironmental circumstances include?
social support - who would be available to elder if they become ill
