Geriatric Assessment Flashcards
7 things included in geriatric assessment
1-physical assessment 2-cognitive assessment 3- functional assessment 4-social assessment 5- family history 6- medical history and medications 7- lab test
Assessment is tailored to individual based on what(5)
1- age 2- frailty 3- living situation 4-includes caregiver and family 5- includes interdisciplinary team
Physical assessment includes what things and examples
- Observations - are clothes fitting lose ? Indication of weight loss issues
- Vital signs - heart rate( acetylcholine esterase inhibitors decrease heart rate), o2 saturation, blood pressure( orthostatic hypotension), weight
- Cardiovascular (ekg), Musculoskeletal ( strength ; can use physical therapy),Abdominal
- Urologic (PSA), Neurological, others
- look at Eyes, Ears, Mouth( swallowing issues or dry mouth)
2 Medication adherence tools
Modified -Morisky scale-ask yes or no questions/ validity questionable because false results
Trail B test - connect the dots
2 types of medication non-adherence
Intentional- not taking because of COST or SIDE EFFECTS
Non intentional - the Regimen is too complex or patient forgets
3 categories to look at for medication assessment
1-immunizations
2-adherence
3-medication duration- There should be documentation of when a medication was initially started or assessed to avoid overtreatment.
Duration of Bisphosphonate Alendronate- Fosamax Risendronate- Actonel, Altevia Etidronate-Didronel Ibandronate- Bonita Tiludronate- Skelid Pamidronate Zoledronic- Zometa
3 to 5 years because long term use may be associated with risk of femur FRACTURES or Esophageal CANCER
Duration of PPI FOR GERD
Less than 1 month because of
1- fractures
2-malabsorption
3-electrolyte issues like Magnesium
Duration of dual anti-platelets
1 to 2.5 years because of GI bleed risk
Duration of SSRIs
1-2 years
Duration of tamoxifen
5 years but 10 years for people with ER- positive disease
ER positive means cancer grows in RESPONSE to ESTROGEN hormone.
6 cognitive assessment
1-MMSE(mini mental state exam) -copyrighted and must pay fee, most common and simple
2-MoCA( Montreal cognitive assessment)- have greater than 20 languages, more sensitive that MMSE
3-SLUMS- Saint Louis University Mental Status Exam- rarely used
4- SBT ( short blessed exam)- evaluates 6 items; more sensitive than MMSE
5-ADAS- cog( Alzheimer’s disease assessment scale) cognitive sub scale- for RESEARCH purpose
6-CDR( clinical dementia rating)-valid next to MoCA and MMSE; must go through training to administer and it takes 45 MINUTES, good for patients who can’t do pencil and paper test because it’s a conversation with the caregiver
Which test is used for executive function?
Trail Making Tests
TMT-B
- connect the dots
- a timed test
What can Trail Making test predict (3)
Predictive of 1)medication adherence
2) whether someone should be driving
3) whether someone is able to handle finance
Neuropsychiatric assessment for depression (3)
1-GDS - geriatric depression scale
- long form (30 items)and short form( 15 items); SHORT form most often used and 6 or more is positive
2-Patient health questionnaire- PHQ-2 and PHQ-9
3- ( CSDD) -Cornell Scale for Depression in Dementia ( rating based on patients signs and symptoms over 1 week); >12 is probable Depression
Name 3 neuropsychiatric assessment for Behavior
1- BEHAVE-AD ( behavioral pathology in Alzheimer’s disease rating scale)
2-NPI( neuropsychiatric inventory)
3-NPI-Q ( questionnaire)
- can be validated against NPI
- can be done in less than 5 minutes
- 13 yes or no questions and severity questions
* NPI-Q and BEHAVE -AD are used in research settings
3 functional assessment for falls/balance
1-Timed up and go test- from seated position you rise walk 3 meters and return and sit >14 seconds is a fall risk but < 20 seconds is INDEPENDENT
2-Romberg test- stand with feet together with eyes open and closed
3-Five times sit to stand- arms crossed, sit and stand 5 times ( > 14 seconds is a fall risk)
6 ways to assess for Pain ( alphabets)
PQRSTU Provoking- what makes it better or worse Quality-stabbing , tingling, elephant on chest Region/Radiates Severity Timing/ Temporal U (you) -how is it impacting you
Name 4 Pain scales
1) 0-10 numeric rating scale
2) Verbal descriptor
3) Face Pain scale - Wongbakerfaces
4) Pain Thermometer
Nutritional assessment (6)
Mini- Nutritional Assessment ( MNA)
MNA-short form ( MNA-SF)- preferred form
MUST( MALNUTRITION universal screening tool)-
SNAQ- simplified nutritional appetite questionnaire
SGA-subjective global assessment
SCREEN -Seniors in the Community Risk Evaluation for Eating and Nutrition 2 ( screen 2)
What is AIMS assessment
Abnormal involuntary movement scale
- it test for tardive dyskinesia over time in patients taking neuroleptic( also known as antipsychotics)medications that are dopamine blocking agents like 1st and 2nd generation antipsychotics ( 1st generation more severe) and other dopamine blocking agents like METOCLOPRAMIDE
