Geriatric Assessment Flashcards
Define Geriatric Assessment
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
Goals of a Geriatric Assessment
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
Items Elderly Patients Present with
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
Office Environment for the Elderly
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
Patient Encounter with an Elderly Person
Address patient with title & last name
Make patient the focus of attention
Direct all questions to the patient
Family may be present
Family Members in on an Elderly Patient’s Visit
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
Problem List in the Geriatric Population
All problems Medical illnesses Risk factors Family history Other issues
Things to Consider with the Problem List of a Geriatric Patient
Formal diagnosis with functional severity
Syndromic problems that require a specific therapeutic plan
Contributory life events
Living circumstances
Medications
Hx of continuing significance
Lifestyle
Living Circumstances
Alone
Caretaker
Family
Nursing home or assisted living
Hx of Continuing significance
ETOH Tobacco use Hysterectomy Depression Suicide attempt
Lifestyle Items of Importance
Social network
Volunteer
Do you drive?
Areas of Assessment & Screening in the Geriatric Population
Cognition Function (ADLs & IADLs) Mood Mobility Nutrition Continence Vision Hearing ETOH use Social & economic issues CAREGIVER!!!
Assessing Mental Status Changes
Mini mental status exam
Mini Mental Status Exam
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
Parts of the Mini Mental Status Exam
Orientation Registration Attention & Calculation Recall Language
Define Functional Assessment
Patient is doing as much as possible physically, intellectually, socially, and being as independent as possible is a major objective of geriatric care
Reason for Monitoring Functional Assessment
Helps to appreciate deterioration & improvement over time
What is vital to properly make any medical decisions?
Knowledge of the premorbid functionality & living situation
Define Activities of Daily Living
Skills needed to live at home
Define Instrumental Activities of Daily Living
Skills needed to live independently in the community
Basic ADLs
Personal hygiene Dressing & undressing Eating Transferring from bed to chair & back Toileting Continence Communication Visual capability Use of the upper extremities
What is the physical self-maintenance scale used for?
Assesses need for services
Assess level of care needed when placement is anticipated
Most indicated when functionality is a major or likely issue
Instrumental Activities of Daily Living
Obtaining & preparing food Manage transportation Laundry Housekeeping Using the telephone Managing finances Medication
What is the functional activities questionnaire used for?
Determine ability to do each IADL
Able to grade each function
Tailor to individual needs with each function
How to check for depression in the elderly?
Geriatric depression scale
How to check for mobility in the elderly?
Get up and go test
Nutrition in the Elderly Population
Eating at least 2 meals a day
Mini-nutritional assessment
Checking for Continence in the Elderly Individual
Ever lose your urine & get wet?
Use depends or pads?
Checking for Fall Risk in Elderly Individuals
Fall & hurt yourself?
Afraid you will fall because of balance or walking problem?
Fallen 2+ times?
Testing for Vision Problems
Near & far vision questions Amsler grid (macular degeneration)
Testing for Hearing Problems
Ear exam
Audiology screening
How to assess alcohol use in a geriatric patient?
CAGE questionnaire Geriatric MAST (Michigan alcoholism screening test)
Why assess the caregiver?
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
Aspects of Caregivers that Make Them Especially Vulnerable to Stress
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
Contributing Factors to the Caregivers Own Frailty
Spouse is caregiver 70 y/o caregiver to 90 y/o patient ETOH Depression Illness Caregiver demands (parent & children)
Contributing Factors to the Stressful Aspect of the Patient
Disturbed nights Uncontrolled aggression Wandering Falling Uncontrolled incontinence Inability to walk without assistance
Office Assessment of a Geriatric Patient
Baseline History
Comprehensive physical exam
Important Vital Signs of a Geriatric Patient
Height Weight BMI BP supine & upright Respirations
Important Items to Notice on Skin Exam
Abnormal lesions
Pressure sores
Signs of trauma
Dry mouth & lips
Important HEENT Items
Hearing Vision Oral mucosa Dentition Oral cancers Thyroid
Important Chest Findings
Kyphosis & severity
Important Cardiac Findings
Rate/rhythm
S3, S4
Murmurs
Carotid bruits
What can we elicit from an abdominal exam?
Constipation
Pressure sensors of pain
Bowel sounds
Over distended bladder
GU Exam in the Geriatric Population
DRE
Vulva for abnormalities
Palpable ovaries or uterus
Musculoskeletal Exam in the Geriatric Population
Get up & go test (gait & mobility)
Have them touch the back of their head with their hands
Pick up a spoon
Neurological Exam in the Geriatric Population
Mental status
Cranial nerves
DTRs
Sensation, vibration senses
Preference for Care
Explore patients values
Ask about advanced directives
Office Assessment Over Time
One medication adjustment at a time
Observe target symptoms & effectiveness
Allows growing familiarity with capacity & capability of patient & family
Benefits to a Geriatric Assessment
New diagnosis Fewer medications Improved functional status Preserving independence Increased use of home health services
4 Parts to a Geriatric Plan
Therapeutic interventions
Health maintenance
Rehabilitative techniques
Patient & family education
