Geriatric Assessment

Question 1

Physical assessments

Answer 1

• Weight
  
  • Vital signs
  • Vision
    Ear and oral assessments

Question 2

System assessment

Answer 2

• Neurological assessment (Cranial Nerves, Cerebellar Dysfunction)
  
  • Cardiovascular assessment
  • Respiratory Assessment
  • Nutrition/ Elimination/ Pain: Abdominal assessment
    Falls/ Mobility: Reflex, gait and strength assessments

Question 3

What assessment tools should we use?

Answer 3

• Screening tools:
  ○ MoCA, Frailty Scale, Geriatric Depression scale
  
  • Comprehensive assessments:
    ○ FANCAPES, FULMER SPICES, Comprehensive Geriatric Assessment
  • BMI Calculator
  • Orthostatic vital signs:

Question 4

Ear Examination

Answer 4

• Cerumen Impaction
  
  • Whisper Test
    Weber and Rinne test

Question 5

Oral Assessment

Answer 5

• Ulcers
  ○ May be caused by nutritional deficiencies
  
  • Dental Carries
    ○ Can be painful, may result from poor oral hygiene
  • Oral Thrush
    ○ An overgrowth of yeast, may be caused by steroid inhalers
  • Xerostomia
    Fancy word for dry mouth, often caused by medication

Question 6

Neurological assessments: Cranial Nerves

Answer 6

• Numerous disorders in the elderly can cause dysfunction of cranial nerves
  ○ Examples: stroke, Parkinson’s, peripheral neuropathy, herniated disc, arthritis, MS
  
  • Cranial nerve dysfunction can cause motor and/or sensory issues depending on what nerves are impacted
    ○ Examples: balance issues, hearing loss, visual disturbance, speech, swallowing, pain perception
  • Cranial Nerve 9, 10 – glossopharyngeal and Vagus
    ○ Phonation “ah”
    ○ Swallowing
    ○ Gag reflex
  • Cranial Nerve 7 (Facial)
    ○ Facial symmetry
    ○ Ability to raise eyebrows, frown, smile, close eyes tightly, puff out cheeks
  • Cranial Nerve 3, 4, 6 – Oculomotor, trochlear, abducens
    ○ Light pupillary response
    ○ Extra-ocular movement (six cardinal positions of gaze)

Question 7

Cerebellar Dysfunction

Answer 7

• The Cerebellum is the part of the brain responsible for coordination
  
  • Disorders such as alcohol misuse, stroke, tumor, brain degeneration, MS, and certain medications (i.e., benzodiazepines, antiepileptics) can cause cerebellar dysfunction
  • Assessment findings in cerebellar dysfunction may include:
    ○ Nystagmus
    ○ Action tremor
    ○ Dysmetria in upper or lower extremities – i.e., rapid alternating movements, finger-finger, finger-nose, heel- shin
    Gait ataxia

Question 8

Visual Acuity

Answer 8

• Snellen Chart
  
  • Assess from 20 meters (6 feet) away
    Assess right and left eye

Question 9

Gait Assessment

Answer 9

• Assess normal gait, tandem gait, heel walking, and toe walking
  
  • Common abnormal gaits in the elderly population:
  • Timed Get Up and Go Test Video Demonstration:
  • Step:
    ○ The distance from one heel strike to the next contralateral heel strike
    ○ Normal: About 72 cm
  • Stride:
    ○ The distance covered from one heel strike to the next ipsilateral heel strike (2 steps)
    ○ Normal: About 144 cm
  • Cadence (step rate):
    ○ Number of steps per unit of time
    ○ Normal:90-120steps/minute
  • Gait speed:
    ○ Distance covered in a given amount of time
    ○ TUG Test
  • Step or base width:
    ○ The lateral distance between the heel centers of two consecutive foot contacts
    Normal:5-10cm

Question 10

Strength Assessment

Answer 10

• 0/5: no contraction
  
  • 1/5: muscle flicker, but no movement
  • 2/5: movement possible, but not against gravity
  • 3/5: movement possible against gravity, but not against resistance by the examiner
  • 4/5: movement possible against some resistance by the examiner
    5/5: normal strength

Question 11

Reflex Assessment

Answer 11

• 0 = no response
  
  • 1+ = a slight but definitely present response
  • 2+ = a brisk response; normal.
  • 3+ = a very brisk response
    4+ = clonus

Question 12

Cardiovascular Assessment

Answer 12

• Edema
  
  • Peripheral Vascular Disease
  • Murmur
    Jugular Venous Pulse

Question 13

Respiratory Assessment

Answer 13

• Respiratory rate
  
  • Auscultate lungs
  • Cap refill, digital clubbing, peripheral cyanosis
  • Posture
    Stigmata of COPD

Question 14

Abdominal Assessment

Answer 14

• Pain
  
  • Distention
  • Masses
  • Palpable bladder
    Rectal exam if constipated