geriatric assessment Flashcards
what is our goal in geriatric assessment
measure preserve and nurture the functional status
Geriatric assessment encompasses four main domains of patient care and those are
Geriatric assessment encompasses four main domains of patient care: mental, physical, functional, and social/economic.
important Hx you want to gather in geriatric assessment
ros
medications
problem lists
Barriers to Care of the Elderly
Beliefs about “normal” symptoms of aging
Access to care
Denial, fear, negativity
Cultural barriers
Western medicine does not“let people be”
It takes a long time (for us, for them)
Multiple medical diagnoses, issues
Altered central processing seen in the elderly
Cellular aging
Pre-existing brain dz (dementia)
Current illness affecting brain function
when an elderly person has an infection or sepsis they
may present with confusion
Neuronal degeneration presents these two ways in the elderly
Reduced muscle strength, balance
Reduced peripheral sensitivity
where do you go when your geriatric pt complains of fatigue
ROS
when should you be highly suspicious of sxs in elderly
High suspicion for sx’s which appear abruptly or rapidly over a few days
what should be on your ddx if you hear “my dad is not eating”:
often abdominal issue
suspect diverticulitis
what should you suspect when you see delirium sxs in an adult
Delirium, altered mental status
Fever, leukocytosis may be absent
not going to mount a white count if you don't see these
things
Think urinary tract infection FIRST
Both men and women
acute abd
surgical abd
today
May have minimal abdominal complaints
Change in mental status
Stop eating/drinking
acute abd
shortness of breath in a geriatric pt
you should suspect
acute MI
most common sxs
epigastric pain
chest pain?
sweaty?
shortness of breath?
inferior wall MI until proven otherwise
could be GERD but always suspect MI
Confusion, EtOH, isolation, weight loss, vitamin deficiency, anemia
Depression
Delayed presentation, often cannot transport self to office/hospital
Neglect, wounds, fractures
“i don’t remember”
elder abuse
PMH in geriatrics
Illnesses, Hosp/Surg
Recent labs/tests
Get old medical records
Specialists
standard ROS in elderly
Sleep (how did you sleep and how are you sleeping) weight (loss= cancer or active AIDS), appetite
Skin, sores (bruises don’t heal as well and skin is thin)
Vision, hearing, teeth, swallowing
SOB, chest pain, palpitations
Abd pain, digestion (tomatoes for lunch not for dinner), changes in stool (are you bm regular?)
Urinary sx’s and bladder function
Syncope, weakness
Depression, mood changes, Hx mental illness
Social Hx for geriatrics
Caregivers/Contacts/Support Sexual function/activity Exercise Dietary habits/Nutrition Tobacco/Alcohol/drugs
Comp assessment geriatrics
Function – ADL’s, IADL’s, vision, hearing, etc Cognitive - memory, confusion, etc Safety - stairs, lighting, abuse, etc Falls Transportation Activities Advanced Directives
SPLATT
Symptoms - before/after Previous falls Location Activity Time of day Trauma
mindfulness with interview
Adequate time. Review old record
May undress after history
Pace of questions, volume of your voice, manners
Face the patient, interpreter
Obtain history from patient when possible. Include spouse, family, caregiver when appropriate
Balance between listening and efficiency
Hold your place
what do you want to pay attention to in the pE with regards to general appearance
General - dress, hygiene, mood, fitness
what do you want to pay attention to in the pE with regards Vitals
Vitals - pulse, orthostatics, height/weight
