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Geriatrics > Geriatric Assessment > Flashcards

Geriatric Assessment Flashcards

1
Q

Define Geriatric Assessment

A

Multidimensional diagnostic approach to the screening & diagnosis of the physical, psychological & social impairments and the attendant functional disabilities in the frail elderly with the objective of developing an overall treatment plan which will improve the patient’s QOL

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2
Q

Goals of a Geriatric Assessment

A

Define functional capabilities & disabilities
Evaluate the mental & emotional strengths & weaknesses
Appropriately manage acute & chronic diseases
Promote prevention & health
Establish preference for care in various situations
Understand financial resources available for care
Understand social networks & family support systems of care

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3
Q

Items Elderly Patients Present with

A

Complex medical, psychological & social problems that are managed by multiple providers
Long medication lists
Cognitive issues
Hearing impairment
Functional disabilities not found in a traditional H&P

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4
Q

Office Environment for the Elderly

A 
Limit background noise
Adequate lighting
Comfortable seating
Privacy
Face the patient & speak in a low-pitched voice
Providing pen & paper
Encourage nodding or shaking of the head
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5
Q

Patient Encounter with an Elderly Person

A

Address patient with title & last name
Make patient the focus of attention
Direct all questions to the patient
Family may be present

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6
Q

Family Members in on an Elderly Patient’s Visit

A

Understand that the patient should answer all questions
Can provide details about patient’s illness & social situation
Assist with the treatment plan
Work as a team in achieving goals of care
Crucial to the care of patients with advanced dementia

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7
Q

Problem List in the Geriatric Population

A 
All problems
Medical illnesses
Risk factors
Family history
Other issues
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8
Q

Things to Consider with the Problem List of a Geriatric Patient

A

Formal diagnosis with functional severity
Syndromic problems that require a specific therapeutic plan
Contributory life events
Living circumstances
Medications
Hx of continuing significance
Lifestyle

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9
Q

Living Circumstances

A

Alone
Caretaker
Family
Nursing home or assisted living

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10
Q

Hx of Continuing significance

A 
ETOH
Tobacco use
Hysterectomy
Depression
Suicide attempt
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11
Q

Lifestyle Items of Importance

A

Social network
Volunteer
Do you drive?

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12
Q

Areas of Assessment & Screening in the Geriatric Population

A 
Cognition
Function (ADLs & IADLs)
Mood
Mobility
Nutrition
Continence
Vision
Hearing
ETOH use
Social & economic issues
CAREGIVER!!!
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13
Q

Assessing Mental Status Changes

A

Mini mental status exam

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14
Q

Mini Mental Status Exam

A

Tests several areas of cognitive function
Measure of change over time
Encourage patient to make his/her best guess in response to the more factual questions

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15
Q

Parts of the Mini Mental Status Exam

A 
Orientation
Registration
Attention & Calculation
Recall
Language
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16
Q

Define Functional Assessment

A

Patient is doing as much as possible physically, intellectually, socially, and being as independent as possible is a major objective of geriatric care

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17
Q

Reason for Monitoring Functional Assessment

A

Helps to appreciate deterioration & improvement over time

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18
Q

What is vital to properly make any medical decisions?

A

Knowledge of the premorbid functionality & living situation

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19
Q

Define Activities of Daily Living

A

Skills needed to live at home

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20
Q

Define Instrumental Activities of Daily Living

A

Skills needed to live independently in the community

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21
Q

Basic ADLs

A 
Personal hygiene
Dressing & undressing
Eating
Transferring from bed to chair & back
Toileting
Continence
Communication
Visual capability
Use of the upper extremities
22
Q

What is the physical self-maintenance scale used for?

A

Assesses need for services
Assess level of care needed when placement is anticipated
Most indicated when functionality is a major or likely issue

23
Q

Instrumental Activities of Daily Living

A 
Obtaining & preparing food
Manage transportation
Laundry
Housekeeping
Using the telephone
Managing finances
Medication
24
Q

What is the functional activities questionnaire used for?

A

Determine ability to do each IADL
Able to grade each function
Tailor to individual needs with each function

25
Q

How to check for depression in the elderly?

A

Geriatric depression scale

26
Q

How to check for mobility in the elderly?

A

Get up and go test

27
Q

Nutrition in the Elderly Population

A

Eating at least 2 meals a day

Mini-nutritional assessment

28
Q

Checking for Continence in the Elderly Individual

A

Ever lose your urine & get wet?

Use depends or pads?

29
Q

Checking for Fall Risk in Elderly Individuals

A

Fall & hurt yourself?
Afraid you will fall because of balance or walking problem?
Fallen 2+ times?

30
Q

Testing for Vision Problems

A 
Near & far vision questions
Amsler grid (macular degeneration)
31
Q

Testing for Hearing Problems

A

Ear exam

Audiology screening

32
Q

How to assess alcohol use in a geriatric patient?

A 
CAGE questionnaire
Geriatric MAST (Michigan alcoholism screening test)
33
Q

Why assess the caregiver?

A

Check for quality, skills & knowledge of caregiver essential determinants of the standard of care, potential for future care
Good caregiver = therapeutic tool
Poor caregiver = precipitates hospital or institutional placement or abuse
Ensure caregiver is not burnt out

34
Q

Aspects of Caregivers that Make Them Especially Vulnerable to Stress

A 
Their own frailty
Stressful aspect of the patient
Some attempt to "do everything" to alleviate guilt or prior poor relationship
Others encourage independence
Overzealous care can induce dependence
35
Q

Contributing Factors to the Caregivers Own Frailty

A 
Spouse is caregiver
70 y/o caregiver to 90 y/o patient
ETOH
Depression
Illness
Caregiver demands (parent & children)
36
Q

Contributing Factors to the Stressful Aspect of the Patient

A 
Disturbed nights
Uncontrolled aggression
Wandering
Falling
Uncontrolled incontinence
Inability to walk without assistance
37
Q

Office Assessment of a Geriatric Patient

A

Baseline History

Comprehensive physical exam

38
Q

Important Vital Signs of a Geriatric Patient

A 
Height
Weight
BMI
BP supine & upright
Respirations
39
Q

Important Items to Notice on Skin Exam

A

Abnormal lesions
Pressure sores
Signs of trauma
Dry mouth & lips

40
Q

Important HEENT Items

A 
Hearing
Vision
Oral mucosa
Dentition
Oral cancers
Thyroid
41
Q

Important Chest Findings

A

Kyphosis & severity

42
Q

Important Cardiac Findings

A

Rate/rhythm
S3, S4
Murmurs
Carotid bruits

43
Q

What can we elicit from an abdominal exam?

A

Constipation
Pressure sensors of pain
Bowel sounds
Over distended bladder

44
Q

GU Exam in the Geriatric Population

A

DRE
Vulva for abnormalities
Palpable ovaries or uterus

45
Q

Musculoskeletal Exam in the Geriatric Population

A

Get up & go test (gait & mobility)
Have them touch the back of their head with their hands
Pick up a spoon

46
Q

Neurological Exam in the Geriatric Population

A

Mental status
Cranial nerves
DTRs
Sensation, vibration senses

47
Q

Preference for Care

A

Explore patients values

Ask about advanced directives

48
Q

Office Assessment Over Time

A

One medication adjustment at a time
Observe target symptoms & effectiveness
Allows growing familiarity with capacity & capability of patient & family

49
Q

Benefits to a Geriatric Assessment

A 
New diagnosis
Fewer medications
Improved functional status
Preserving independence
Increased use of home health services
50
Q

4 Parts to a Geriatric Plan

A

Therapeutic interventions
Health maintenance
Rehabilitative techniques
Patient & family education

Geriatrics (15 decks)

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