Geriatric Assessment Flashcards
What do you think are some issues in geriatrics that complicate the assessment of the patient??
Elderly patients often present with: 5
- Complex medical, psychological and social problems that have previously been managed by multiple healthcare providers
- Long lists of medications
- Cognitive issues
- Hearing impairment
- Functional disabilities NOT uncovered by the traditional history and physical!
Geriatric assessment should be what?
7
- Limit background noise
- Adequate lighting
- Comfortable seating
- Privacy (bring hearing aids and shut doors)
- Face the patient and speak in a low-pitched voice
- Providing paper and pen
- Encourage nodding or shaking of the head
What should be on the problem list for a geriatric assessment?
5
- All problems
- Medical illnesses
- Risk factors
- Family History
- Other issues
- Impacting further medical or social decision making - Formal diagnoses with indication of functional severity if appropriate
OA, stroke, CHF - Syndromic problems that require a specific therapeutic plan
Falling, instability - Contributory life events
Death of spouse
9. Living Circumstances Alone Caretaker With family Nursing home/Assisted living
Areas of Assessment and Screening? 11
- Cognition
- Function (ADL’s, IADL’s)
- Mood
- Mobility
- Nutrition
- Continence
- Vision
- Hearing
- ETOH use
- Caregiver
- Social and Economic Issues
MMSE tests what? 5
- Orientation
- Registration
- Attention and Calculation
- Recall
- Language
Describe the clock drawing test?
3
- Instruct patient to draw a clock
- Place hands at “20 past 8” or “10 past 11”
- Watch change in clock over time
A technically perfect clock would be unlikely in a person with significant degree of cognitive change.
How do we assess function? 2
- ADLs (Activities of Daily Living) skills needed to live at home
- IADLs (Instrumental Activities of Daily Living) skills needed to live independently in the community
Basic ADL’s
6
- Personal Hygeine
- Dressing and undressing
- Eating - Feeing self
- Tranferring from bed to chair and back
- Toileting
- Continence
What scale is best indicated when functionality is a major or likely issue?
(Dementia or Chronically disabled)
Assesses what? 2
-PSMS – The Physical Self-Maintenance Scale
- Assesses need for services
- Assess level of care needed when placement is anticipated.
IADL’s
7
- Obtaining and Preparing Food
- Manage transportation
(Driving, bus schedule, taxi and Shopping, cooking) - Laundry
- Housekeeping
- Using the telephone
- Managing Finances
- Medication
IADL’s
FAQ – The Functional Activities Questionaire
Benefits? 3
- Able to grade each function
- Tailor to individual needs with each function
- Can be completed by family members, home health workers, social workers
What test assesses Depression?
What test asseses Mobility?
- Depression
Geriatric Depression Scale - Mobility
Get UP and Go test
What should we assess for nutrition?
3
- WEIGHT IS A GERIATRIC VITAL SIGN!!
- “Do you eat less than 2 meals a day?”
- Mini-Nutritional Assessment
Aspects of caregivers that make them especially vulnerable to stress include.
Their own frailty? 6
- Spouse is caregiver
- 70 y/o caregiver to 90 y/o parent
- ETOH
- Depression
- Illness
- Caregiver demands (sandwich generation)
Aspects of caregivers that make them especially vulnerable to stress include.
Stressful aspect of the patient?
6
1 Disturbed nights
- Uncontrolled aggression
- Wandering
- Falling
- Uncontrolled incontinence
- Inability to walk without assistance
Office Assessment
What should be included in this?
12
- Observation of gait and balance
- Weight, height, BMI
- Temperature
- Blood pressure
- Skin
- Eyes, ears, mouth, neck
- Heart and chest
- Upper extremities and hands
- Lower extremities feet
- Abdomen
- Range of movement
- CNS
ON PE what should we look for on skin? 4
- Abnormal lesions
- Pressure sores
- Signs of trauma
- Dry mouth and lips
For chest inspection on the Pe why would kyphosis be detrimental to the pt?
Pain, breathing - intrudes on lung volumes
What should we be assessing in the CV exam?
4
- Rate and Rhythm
- S3, S4
- Murmurs
- Carotid Bruits
What should we look for on the abdominal exam? 4
- Bowel sounds
- Fecal impaction
- Over distended bladder
- Finding may be subtle (Even a soft, mildly tender abdomen can mean the presence of a serious surgical disease)
What should we look for on GU exam? 3
What position should they be in for the pelvic exam?
- DRE
- Vulva for abnormalities
- Palpable ovaries or uterus
Pelvic exam (if needed) needs small speculum and positioning on side with knees drawn up
Musculoskeletal exam for elderly
- LE?
- UE? 2
- Lower extremities
-Gait and mobility!!!!
Get up and go test - Upper extremities
- Touch the back of your head with your hands
- Pick up the spoon
Neuro exam?
4
- Mental status
- Cranial nerves
- DTR’s
- Sensation, vibratory senses
Geriatric Assessment Benefits
5
- New diagnosis
- Fewer medications
- Improved functional status
- Preserving independence
- Increased use of Home Health Services
