Geriatric Assessment Flashcards
Comprehensive Geriatric Assessment: goal
Identify common health conditions in older adults (ex. medical, psychosocial, financial, environmental and functional limitations)
Who should get a geriatric assessment?
- CHF
- Cancer
- Dementia
- Falls
- Previous or predicted high health care need
Who shouldn’t have a comprehensive geriatric assessment?
- If they are too sick (ex. terminal, severe dementia, inevitable nursing home placement)
- Too well to benefit
What’s a “rolling” assessment?
targeting one area to focus on each visit, comprehensive just over several visits
What are the 4 parts of a structured approach?
- Functional capacity
- Physical health (pharmacy)
- Cognition/Mental health
- Socio-environmental
Identify and define the 2 key divisions of functional status
- Basic activities of daily living (ADL) - ex. bathing, dressing, tolieting, grooming, feeding
- Instrumental activities of daily living (IADL) - housework, preparing meals, taking meds, using phone, managing finances
What are the 5 most important topics to include in the physical health section?
- Nutrition
- Vision/hearing
- Fecal and urinary continence
- Balance and fall prevention, osteoporosis
- Polypharmacy
What are the 4 components specific to the geriatric assessment of nutrition?
- Nutritional history w/ nutritional health checklist
- Record of usual food (24 hr recall)
- Physical exam with focus on signs of inadequate nutrition
- Labs, if applicable
Who needs to be screened for hearing loss?
everyone 65+
survey, whispered voice test, audiometry
What does a 10-24 score mean on a hearing inventory?
mild to moderate hearing loss –> refer this patient to ENT
What does a score of 26 to 40 mean on a hearing inventory test?
84% probability they have hearing impairment. Severe handicap–>refer these patients
Patient’s scoring what need to be referred to ENT for hearing loss
0-8 –> no referral
10-40 –> refer to ENT
What tool is helpful for assessing balance and whether they are at higher risk for a fall?
Tinetti Balance and Gait evaluation
7-10 sec: normal
10-19 sec: fairly normal
20-29 sec: variable
30+: functionally dependent
What is the USPSTF recommendation for osteoporosis screening?
routine screen for women 65+ with DEXA of femoral neck
T-score -2.5 of less is osteoporosis
Name some important drugs to avoid on the Beers criteria
- Chlorpheniramine
- Diphenhydramine
- Hydroxyzine
- Nitrofurantoin
- Alpha-1 blockers (prazosin, doxazosin)
- Atropine
What are the 2 questions that are important to be asked during a cognition/mental health screen for depression
- “During the past month, have you been bothered by feeling down, depressed, or hopeless?”
- “During the past month, have you been bothered by little interest or pleasure in doing things”
(if positive, ask the other 7 questions to complete the 9 question Patient Health Questionnaire)
A PHQ-9 score of 1-4 is what?
minimal depression
PHQ-9 score of 5-9 is what?
mild depression
PHQ-9 score of 10-14 is what?
moderate depression
PHQ-9 score of 15-19 is what?
moderate-severe depression
PHQ-9 score of 20-27 is what?
severe depression
How long does the MMSE (mini mental status exam) take?
7 minutes
How many questions are in the mini-cog assessment for quick initial screening?
3 questions
Ex.
- repeat 3 words
- Draw clock set to 11:10
- Recall 3 words from step 1.
What is the result of the mini-cog if the patient correctly recalls 2 words and doesn’t draw the clock right?
positive for dementia
