Geriatric Assessment

Question 1

7 things included in geriatric assessment

Answer 1

1-physical assessment 
2-cognitive assessment 
3- functional assessment 
4-social assessment 
5- family history 
6- medical history and medications 
7- lab test

Question 2

Assessment is tailored to individual based on what(5)

Answer 2

1- age
2- frailty 
3- living situation 
4-includes caregiver and family
5- includes interdisciplinary team

Question 3

Physical assessment includes what things and examples

Answer 3

• 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)

Question 4

2 Medication adherence tools

Answer 4

Modified -Morisky scale-ask yes or no questions/ validity questionable because false results
Trail B test - connect the dots

Question 5

2 types of medication non-adherence

Answer 5

Intentional- not taking because of COST or SIDE EFFECTS

Non intentional - the Regimen is too complex or patient forgets

Question 6

3 categories to look at for medication assessment

Answer 6

1-immunizations
2-adherence
3-medication duration- There should be documentation of when a medication was initially started or assessed to avoid overtreatment.

Question 7

Duration of Bisphosphonate
Alendronate- Fosamax
Risendronate- Actonel, Altevia
Etidronate-Didronel
Ibandronate- Bonita
Tiludronate- Skelid
Pamidronate
Zoledronic- Zometa

Answer 7

3 to 5 years because long term use may be associated with risk of femur FRACTURES or Esophageal CANCER

Question 8

Duration of PPI FOR GERD

Answer 8

Less than 1 month because of
1- fractures
2-malabsorption
3-electrolyte issues like Magnesium

Question 9

Duration of dual anti-platelets

Answer 9

1 to 2.5 years because of GI bleed risk

Question 10

Duration of SSRIs

Answer 10

1-2 years

Question 11

Duration of tamoxifen

Answer 11

5 years but 10 years for people with ER- positive disease

ER positive means cancer grows in RESPONSE to ESTROGEN hormone.

Question 12

6 cognitive assessment

Answer 12

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

Question 13

Which test is used for executive function?

Answer 13

Trail Making Tests
TMT-B
- connect the dots
- a timed test

Question 14

What can Trail Making test predict (3)

Answer 14

Predictive of 1)medication adherence

                   2) whether someone should be driving
                   3) whether someone is able to handle finance

Question 15

Neuropsychiatric assessment for depression (3)

Answer 15

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

Question 16

Name 3 neuropsychiatric assessment for Behavior

Answer 16

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

Question 17

3 functional assessment for falls/balance

Answer 17

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)

Question 18

6 ways to assess for Pain ( alphabets)

Answer 18

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

Question 19

Name 4 Pain scales

Answer 19

1) 0-10 numeric rating scale
2) Verbal descriptor
3) Face Pain scale - Wongbakerfaces
4) Pain Thermometer

Question 20

Nutritional assessment (6)

Answer 20

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)

Question 21

What is AIMS assessment

Answer 21

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