Geriatric assessment Flashcards
What is a geriatric assessment
assessment to help identify common health conditions (medical, psychosocial, and functional limitations)
diagnostic and Tx processesGoals to coordinate a plan to maximize overall health with aging
Examples of health conditions in older adults are
Cogniive impairment delirium incontinence malnutrition falls gait disorders pressure ulcers sleep disorders sensory deficits fatigue dizziness
Who needs a comprehensive geriatric assessment
Medical problems (CHF, cancer)
Psychosocial d/o (depression, isolation)
dementia
falls
functional disability
previous or high health care utilization
change in living situations
Who does NOT need a comprehensive geriatric assessment
Patients too well or too sick to benefit
What are NOT inevitable consequences of aging
Decline in function and loss of independence
AKA, they can be helped!
There is a strong dependence between presence of geriatric syndromes and
dependency in ADL
A CGA may include these components
physical cognitive affective social financial environmental spiritual
How are CGA and normal medical evaluation similar and different
CGA incorporates all normal medical Hx (Rx and non-Rx meds, vitamins, herbs, immunizations) PLUS
non medical domains and a focus on functional capacity and QoL
-CGA also uses a multidisciplinary approach (PT, OT, PCP, nutritionist, psychologist, dentist, audiologist, podiatrist, optician)
What is you have a very busy clinical practice?
Do a “rolling” assessment over several visits, screening one domain per visit
Patient driven assessment instruments are very time efficient
What is the 4 step structured approach to a CGA
- Functional capacity
- Physical health (pharmacy)
- Cognition/mental health
- Socio-environmental
What is functional capacity
The ability to preform tasks that are required for living
Basic and Instrumental ADL
What are examples of basic ADL
Eating dressing bathing grooming transferring using toilet controlling bowel and bladder function (Use Katz index of independence in ADL)
What are instrumental ADL
Housework preparing meals taking meds properly managing finances using phone (Use Lawton IADL scale)
What does “physical health” encompass
Nutrition vision/hearing fecal and urinary continence balance and fall prevention (osteoporosis) polypharmacy
Sample geriatric PE findings
HTN, orthostatic hypotension Bradycardia, Irregularly irregular RR >24 Hyper or hypothermia (2/2 thyroid d/o) S4, regurg murmur barrel chest, SOB Breast mass Pulsatile abdominal mass Atrophy of vaginal mucosa, constipation, fecal incontinence, prostate enlargement/nodules, rectal mass, occult blood Foot bunions, onychomycosis; diminished LE pulses, Herberden nodes diminished ROM, pain, dorsal kyphosis, back pain, gait disturbance, leg pain, muscle wasting, proximal muscle pain Erythema
What vitamins are often deficient in older people
Vitamin A, C, D, and B12
calcium
iron
zinc
What 4 components of nutrition are specific to geriatric assessment
- Nutritional history (use checklist)
- 24 hour dietary recall
- PE regarding inadequate nutrition or overconsumption
- Labs (if applicable)- IE B12
Loss of vision in geriatrics is associated with
increased risk of falls, decline in cognition, and increased rate of depression
If functionally impaired, recent cognitive decline, or fall Hx, screen vision
Common causes of vision impairment include
Presbyopia glaucoma diabetic retinopathy cataracts ARMD
Hearing loss in geriatrics is associated with
depression social isolation poor self esteem increased hospitalization cognitive decline functional disability *Screen if 65+*
How do you test hearing
surveys
whispered voice test
audiometry
Screen if 65+
How do you read the hearing handicap inventory scores
0-8= 13% probability of hearing impairment; no handicap 10-24= 50% probability; refer, mild-mod handicap 26-40= 84% probability; refer, severe handicap
How do you Tx hearing loss
Refer to otolaryngologist for hearing aids
Complications of urinary incontinence include
Decubitus ulcers sepsis renal failure UTI increased mortality -->loss of self esteem, restriction of social and sexual activities, depression
