Geriatric Assessment

Question 1

Comprehensive Geriatric Assessment: goal

Answer 1

Identify common health conditions in older adults (ex. medical, psychosocial, financial, environmental and functional limitations)

Question 2

Who should get a geriatric assessment?

Answer 2

• CHF
• Cancer
• Dementia
• Falls
• Previous or predicted high health care need

Question 3

Who shouldn’t have a comprehensive geriatric assessment?

Answer 3

• If they are too sick (ex. terminal, severe dementia, inevitable nursing home placement)
• Too well to benefit

Question 4

What’s a “rolling” assessment?

Answer 4

targeting one area to focus on each visit, comprehensive just over several visits

Question 5

What are the 4 parts of a structured approach?

Answer 5

1. Functional capacity
2. Physical health (pharmacy)
3. Cognition/Mental health
4. Socio-environmental

Question 6

Identify and define the 2 key divisions of functional status

Answer 6

1. Basic activities of daily living (ADL) - ex. bathing, dressing, tolieting, grooming, feeding
2. Instrumental activities of daily living (IADL) - housework, preparing meals, taking meds, using phone, managing finances

Question 7

What are the 5 most important topics to include in the physical health section?

Answer 7

1. Nutrition
2. Vision/hearing
3. Fecal and urinary continence
4. Balance and fall prevention, osteoporosis
5. Polypharmacy

Question 8

What are the 4 components specific to the geriatric assessment of nutrition?

Answer 8

• 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

Question 9

Who needs to be screened for hearing loss?

Answer 9

everyone 65+

survey, whispered voice test, audiometry

Question 10

What does a 10-24 score mean on a hearing inventory?

Answer 10

mild to moderate hearing loss –> refer this patient to ENT

Question 11

What does a score of 26 to 40 mean on a hearing inventory test?

Answer 11

84% probability they have hearing impairment. Severe handicap–>refer these patients

Question 12

Patient’s scoring what need to be referred to ENT for hearing loss

Answer 12

0-8 –> no referral

10-40 –> refer to ENT

Question 13

What tool is helpful for assessing balance and whether they are at higher risk for a fall?

Answer 13

Tinetti Balance and Gait evaluation

7-10 sec: normal
10-19 sec: fairly normal
20-29 sec: variable
30+: functionally dependent

Question 14

What is the USPSTF recommendation for osteoporosis screening?

Answer 14

routine screen for women 65+ with DEXA of femoral neck

T-score -2.5 of less is osteoporosis

Question 15

Name some important drugs to avoid on the Beers criteria

Answer 15

• Chlorpheniramine
• Diphenhydramine
• Hydroxyzine
• Nitrofurantoin
• Alpha-1 blockers (prazosin, doxazosin)
• Atropine

Question 16

What are the 2 questions that are important to be asked during a cognition/mental health screen for depression

Answer 16

1. “During the past month, have you been bothered by feeling down, depressed, or hopeless?”
2. “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)

Question 17

A PHQ-9 score of 1-4 is what?

Answer 17

minimal depression

Question 18

PHQ-9 score of 5-9 is what?

Answer 18

mild depression

Question 19

PHQ-9 score of 10-14 is what?

Answer 19

moderate depression

Question 20

PHQ-9 score of 15-19 is what?

Answer 20

moderate-severe depression

Question 21

PHQ-9 score of 20-27 is what?

Answer 21

severe depression

Question 22

How long does the MMSE (mini mental status exam) take?

Answer 22

7 minutes

Question 23

How many questions are in the mini-cog assessment for quick initial screening?

Answer 23

3 questions

Ex.

• repeat 3 words
• Draw clock set to 11:10
• Recall 3 words from step 1.

Question 24

What is the result of the mini-cog if the patient correctly recalls 2 words and doesn’t draw the clock right?

Answer 24

positive for dementia

Question 25

What is the result if the patient recalls 1 word correctly and draws the clock right?

Answer 25

negative for dementia

Question 26

According to the Nutritional Health Checklist, a score of 0-2 means what?

Answer 26

good nutrition, recheck in 6 months

Question 27

According to the Nutritional Health Checklist, a score of 3-5 means what?

Answer 27

moderate nutritional risk, identify what can improve

-recheck in 3 months

Question 28

According to the Nutritional Health Checklist, a score of 6+ means what?

Answer 28

high nutritional risk

-bring checklist next time you see a provider to discuss this