Comprehensive Geriatric Assessment

Question 1

Goal of comprehensive geriatric assessment?

Answer 1

maximize overall health w/aging

Question 2

Who should receive a comprehensive geriatric assessment?

Answer 2

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

Question 3

What are 2 things that are NOT inevitable consequences of aging?

Answer 3

decline in fx and loss of independence

Question 4

Similarities and differences from standard medical eval?

Answer 4

Incorporates all facets of a conventional medical history

Includes non-medical domains

Emphasis on functional capacity and quality of life

multidisciplinary team

Question 5

What is included in a structured multidimensional approach?

Answer 5

1. functional capacity
2. physical health (pharmacy)
3. cognition/mental health
4. socio-environmental

Question 6

What is functional capacity?

Answer 6

person’s ability to perform tasks that are required for living.

Question 7

What can signal the need for more in-depth eval’s of the pt’s socio-environmental circumstances and need for adtn’l assistance

Answer 7

Deficits in Basic Activities of daily living (ADL)
and
Instrumental activities of daily living (IADL )

Question 8

Examples of Basic ADL’s

Answer 8

self-care activities that a person performs daily

Eating, dressing, bathing, grooming, transferring to bed/chairs, using toilet, controlling bladder and bowel fx’s

Question 9

What tool can you use to assess ADL’s?

Answer 9

Katz Index of independence

Question 10

Examples of IADL’s:

Answer 10

activities needed to live independently

housework, meal prep, taking meds properly, managing finances, telephone use

Question 11

What tool can you use to assess IADL’s?

Answer 11

Lawton instrumental activities questionnaire

Question 12

what are 5 specific topics related to physical health?

Answer 12

1. Nutrition
2. Vision/hearing
3. Fecal and urinary continence
4. Balance and fall prevention, osteoporosis
5. Polypharmacy

Question 13

What are some concerning vital signs?

Answer 13

BP - HTN or orthostatic hypotension
HR - brady or afib
RR - >25
temp - hyper/hypothermia

Question 14

what signs are you looking for on a cardiac exam?

Answer 14

S4
systolic ejection
regurgitant murmurs

Question 15

what signs are you looking for on a pulmonary exam/breast exam?

Answer 15

barrel chest, SOB, masses

Question 16

what signs are you looking for on abdomen, GI, genital/rectal exam?

Answer 16

pulsatile mass, atropy of vaginal mucosa, constipation, fecal incontinence, prostate enlargement/nodules, rectal mass, occult blood, urinary incontinence

Question 17

what signs are you looking for on extremity exam?

Answer 17

abnormalities of the feet, diminished or absent lower extremity pulses, heberden nodes

Question 18

what signs are you looking for on muscular/skeletal exam?

Answer 18

diminished ROM, pain, dorsal kyphosis, vertebral TTP, back pain, gait disturbances, leg pain, muscle wasting, proximal muscle pain or weakness

Question 19

what signs are you looking for on skin exam?

Answer 19

erythema, ulceration over pressure points, unexplained bruises, premalignant lesions

Question 20

Which vitamins are often deficient in elderly?

Answer 20

vitamins A, C, D, and B12 calcium
iron
zinc

Question 21

4 components specific to geriatric nutrition assessment?

Answer 21

1. nutritional health checklist for nutrition hx
2. 24hr dietary recall
3. PE for s/s assoc. w/inadequate nutrition or overconsumption
4. select lab tests

Question 22

Low vision is assoc. w/

Answer 22

increased risk of falls, decline in cognition, and increased rates of depression

Question 23

what are some common causes of vision impairment?

Answer 23

presbyopia, glaucoma, diabetic retinopathy, cataracts, and ARMD (age-related macular degeneration)

Question 24

Who should vision assessments be performed on?

Answer 24

adults with recent cognitive decline, functional impairment, or falls

Question 25

hearing loss is assoc. w/...

Answer 25

depression, social isolation, poor self-esteem, increased hospitalization rates, cognitive decline, and functional disability

Question 26

who should you screen for hearing loss and how?

Answer 26

adults over 65 asses w/ surveys, whisper voice test and audiometry

Question 27

What questionnaire can you use to assess hearing loss?

Answer 27

hearing handicap inventory for the elderly

Question 28

what is one potential cause of hearing loss?

Answer 28

ototoxic drugs

Question 29

who should you refer to if having hearing loss?

Answer 29

Otolaryngologist

Question 30

TOC for hearing loss?

Answer 30

hearing aids

Question 31

urinary incontinence complications?

Answer 31

decubitus ulcers, sepsis, renal failure, urinary tract infections, and increased mortality

Question 32

what major decision do you have to consider if elderly pt is having urinary incontinence?

Answer 32

nursing home placement

Question 33

what should you look for on PE for incontinence?

Answer 33

evaluate fluid overload neurologic function mobility

Question 34

what diagnostic tool can you use to assess balance and fall prevention?

Answer 34

tinetti balance and gait evaluation: get up from chair, walk 10 ft, turn around and come back

Question 35

how can older persons decr their fall risk?

Answer 35

exercise, PT, home hazard assessment, withdrawal of psychotropic meds

Question 36

osteoporosis may result in...

Answer 36

low impact or spontaneous fx's

Question 37

how does the USPSTF recommend screening of women 65+ y/o for osteoporosis?

Answer 37

DEXA of the femoral neck

Question 38

which tool can helps with medication assessment to reduce adverse effects?

Answer 38

Beers criteria (list of meds inapprop. for elderly)

Question 39

what are some atypical sxs that older pt's w/depression present w/?

Answer 39

somatic complaints, cognitive, functional problems, sleep problems, fatigue

Question 40

What 2 Q's should you use to eval depression in elderly?

Answer 40

1. during past mo. have you been bothered by feeling down, depressed, or hopeless? 2. during past mo. have you been bothered by little interest or pleasure in doing things?

Question 41

what is the next step if positive screen for depression w/2 Q's screener?

Answer 41

7 additional questions to complete PHQ-9

Question 42

What does an eval of dementia include?

Answer 42

``` thorough history brief cognition screens detailed mental status exam neuropsychologic testing labs (Vitamin B12, TSH) depression assessment radiographic imaging ```

Question 43

what is the most widely used cognitive test for dementia?

Answer 43

MMSE (mini mental status exam)

Question 44

how do you perform mini-cognitive assessment?

Answer 44

step 1 --> repeat 3 unrelated words step 2 --> pt draw clock set to 11:10 step 3 --> recall 3 words from step 1

Question 45

what does a brief screen of socioenvironmental circumstances include?

Answer 45

social support - who would be available to elder if they become ill