Geriatric Assesments

Question 1

What are the geriatric assessments you need to know about?

Answer 1

Parkinson’s assessment
Suspected Stroke assessment
Comprehensive geriatric assessment

Question 2

What are the components of the comprehensive geriatrics assessment?

Answer 2

Physical health, mental health, social circumstances, functional abilities and environment

Question 3

What are the components of physical health in the comprehensive geriatric assessment?

Answer 3

Past medical history and co-morbidities, medication list, fecal and urine incontinence status, nutritional assessment, skin integrity and falls screen

Question 4

What are the components of the mental health in the comprehensive geriatric assessment?

Answer 4

Cognitive and delirium assessment, mood and anxiety and fears

Question 5

What are the components of the social circumstances in the comprehensive geriatric assessment?

Answer 5

Informal support and social networks, formal support e.g. care packages, statutory care and eligibility, finances

Question 6

What are the components of the environment in the comprehensive geriatric assessment?

Answer 6

Housing, equipment and adaptions, telecare, transport and accessibility

Question 7

Each capacity ruling is specific for what things?

Answer 7

Time specific

Decision specific

Question 8

A person is unable to make a decision if they are unable to:

Answer 8

Understand the information
Retain that information
Weigh up the information
Communicate their decision back

Question 9

What are the components of the Parkinson’s assessment?

Answer 9

Inspection 
Tremor
Rigidity
Gait 
Eye movements 
Speech

Question 10

What are the other tests you would offer to do following Parkinson’s assessment?

Answer 10

Sitting and standing blood pressure (to diagnose orthostatic hypotension a feature of multi system atrophy)
Assessment of micrographia
Formal cognitive test

Question 11

How do you asses tremor in Parkinson’s?

Answer 11

Close eyes and count backward form 20 -resting tremor exacerbated by distraction
Hands outstretched -postural tremor
Move fingers from hand to their nose -action tremor
Spread thumb and index finger and rapidly tap them together, asses speed cadence and amplitude-bradykinesia

Question 12

How do you assess rigidity in Parkinson’s assesment?

Answer 12

Tone as you normally do (look for increased tone and cogwheeling)
If no tremor test synkinesis, as patient to move collateral limb whilst assessing tone

Question 13

What would you expect in the gait of a Parkinson’s

Answer 13

Stooped posture, difficulty initiating movement, short shuffling steps, reduced or absent arm swing, difficulty turning, freezing phenomena and festination (speeding up and shortening step length)

Question 14

How do you test eye movements in Parkinson’s assessment?

Answer 14

As you would in cranial nerve exam
Watch for vertical gaze palsy (progressive supranuclear palsy)
Nystagmus (cerebellar pathology)

Question 15

How do you test speech in a Parkinson’s assessment ?

Answer 15

Ask patient to say British Constitution and baby hippopotamus
Look out for hypophonia
Look out for staccato and dysarthria seen in cerebellar pathology

Question 16

What are the components of a suspected stroke assessment?

Answer 16

ABCD
Everything else- neurological examination of cranial nerves and limbs
Investigations

Question 17

What investigations do you need to arrange for suspected stroke?

Answer 17

CT brain to rule out haemorrhage
ECG to check for cardiac cause of stroke e.g. atrial fibrillation
Bloods including checks for hypoglycemia, hypercholesterolaemia and clotting disorders

Question 18

Define Catatonia

Answer 18

Stopping of voluntary movement or staying still in an unusual position