Geriatric Assessment Flashcards
What should you do prior to appt w/ geriatric pt.?
Review pt’s medical record - lengthy!
What else can you implement to help you maximize your time during an appt w/ a geriatric pt?
Pre-clinic review of systems questionnaire
In geriatric pt. it is important to focus on ________ needs in addition to medical needs
Bio-psycho-social
Unique features of geriatric pt
- Complexity of disease
- Altered response or organ systems
- Chronicity of illness
- Severity of acute illness & slower recovery
- Functional impairments limited independent ADLs
- Fragility (emotional, physical, socioeconomic) of response to illness, intervention, and stress
- Unstable economic & social supports
- Limitation in reversibility of impairments: rehab > cure
Special ROS Considerations
- Cognitive impairment
- Dental status
- Falls
- Foot disorders
- Gait abnormalities
- Hearing loss
- Incontinence
- Nutrition or feeding impairment
- Osteoporosis
- Pressure ulcers
- Psychiatric illness
- Sexual history
- Sleep disorders
- Vision loss
What makes older adults vulnerable?
- Chronic health conditions
- Physical, sensory, cognitive impairments
- Psychological & social factors (health & safety)
- Accessibility, equity, & social determinants
- Finances & family caregiver considerations
The ______________ is a paradigm for approaching older patients who have complex bio-psycho-social needs
WI Star Method
The Wisconsin Star Method takes into account what 5 factors when addressing a patient’s problem or symptoms
Social, medication, medical, behavioral, personal
____________________ is an organizational approach to caring for people with chronic disease in a primary care setting that creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team
Wagner’s Chronic Care Model
Issues in geriatric history taking
- Underreporting of illness
- Illness viewed as normal sign of aging
- Accepting illness as inevitable
- Patient intimidated by busy practitioner
- Denial of illness
- Patient cannot afford to seek care
- Patient fears consequences of reporting sx (test, medication)
- Atypical, nonspecific presentation of illness
- Communication barriers
- Extensive w/ multiple problems
Strategy to ease geriatric history taking
Ask open ended questions
Communication strategies
Control the environment!
- Well-lit room
- Avoid backlighting
- Minimize extraneous noise
- Minimize interruptions
- Consider using voice amplified device
- Avoid multiple concurrent conversations
Goal of geriatric assessment
Promote wellness, independence
Focus of geriatric assessment
Function, performance
Success of geriatric assessment
Maintaining or improving QOL
Strategies for rapid screening: functional status
Answered YES to (1 or more): Because of a health or physical problem, do you need help to
- Shop?
- Do light housework?
- Walk across a room?
- Take a bath or shower?
- Manage the household finances?
Strategies for rapid screening: mobility
Get up & go
Strategies for rapid screening: nutrition
Answered YES to: Have you lost more than 10lb over the past 6 months without trying to do so OR do you have a BMI of <20kg/m2
Strategies for rapid screening: vision
Unable to read a newspaper headline with corrective lens
Snellen: unable to read greater than 20/40
Strategies for rapid screening: hearing
Handheld audioscope, whisper test
- Unable to hear a 40dB tone at 1000 or 2000 Hz in both ears or at either frequency in one ear
Strategies for rapid screening: cognitive function
3 item recall: able to remember 3 items after 3 minutes?
Clock draw test: draw proper display of face, depict correct time
Strategies for rapid screening: depression
Answered YES to: Do you often feel sad or depressed or hopeless? Having little interest or pleasure in doing things?
Complete physical assessment includes
- Functional status
- Nutrition
- Vision
- Hearing
- Assessment of cognition
Poor nutrition may reflect
Medical illness, depression, functional losses, financial hardship
Frailty score: 5 criteria
- Shrinkage (unintentional wt. loss >10lbs)
- Weakness (decrease grip strength)
- Exhaustion (self-reported poor energy, endurance)
- Low physical activity (low energy expenditure)
- Slowness
Interpretation of frailty score
The patient receives 1 pt for each criterion met
0-1 points - frailty score
NOT frail
2-3 points - frailty score
Intermediate frail (“pre-frail”)
4-5 points - frailty score
Frail
Frailty =
Functional decline
How is weakness/decreased grip strength assessed? (frailty score)
Lowest 20th percentile by gender & BMI
Using hand-held dynamometer
How is exhaustion assessed? (frailty score)
If pt reports “moderate amount of time (3-4 days)” or “most of the time” to the following two statement:
- I felt that everything I did was an effort
- I could not get going
How is low physical activity assessed? (frailty score)
Minnesota Leisure Time Activities Questionnaire - lowest 20th percentile by gender:
Male <383 kcal/wk
Female <270 kcal/wk
How is slow walking assessed? (frailty score)
Walking speed in the lowest 20th percentile by gender and height
Time is measured for a distance of 15 feet @ normal pace
Common vision problems in elderly pt.
Cataracts, glaucoma, macular degeneration, accommodation abnormalities
Impaired hearing can lead to
Depression, social withdrawal
What do we assess first when evaluating hearing loss/difficulties?
Cerumen impaction
Vision + hearing problems is related to
Worse outcomes
Prevalence of Alzheimer’s disease:
___% of those 65+
___% of those 85+
10
50
Memory loss is a common complaint of those with dementia - T or F?
False
Cognitively impaired older persons are at increased risk for
- Accidents
- Delirium
- Medical non-adherence
- Disability
What two tests does the Mini-Cog consist of
- 3 item recall (1 point for each correct word)
2. Clock draw (0 point for abnl clock, 2 for normal)
A Mini-Cog score of __ or less suggests possible impairment
2
