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Geriatrics 1 > Geriatric Assessment > Flashcards

Geriatric Assessment Flashcards

1
Q

What should you do prior to appt w/ geriatric pt.?

A

Review pt’s medical record - lengthy!

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2
Q

What else can you implement to help you maximize your time during an appt w/ a geriatric pt?

A

Pre-clinic review of systems questionnaire

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3
Q

In geriatric pt. it is important to focus on ________ needs in addition to medical needs

A

Bio-psycho-social

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4
Q

Unique features of geriatric pt

A
  • 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
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5
Q

Special ROS Considerations

A
  • 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
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6
Q

What makes older adults vulnerable?

A
  • Chronic health conditions
  • Physical, sensory, cognitive impairments
  • Psychological & social factors (health & safety)
  • Accessibility, equity, & social determinants
  • Finances & family caregiver considerations
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7
Q

The ______________ is a paradigm for approaching older patients who have complex bio-psycho-social needs

A

WI Star Method

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8
Q

The Wisconsin Star Method takes into account what 5 factors when addressing a patient’s problem or symptoms

A

Social, medication, medical, behavioral, personal

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9
Q

____________________ 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

A

Wagner’s Chronic Care Model

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10
Q

Issues in geriatric history taking

A
  • 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
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11
Q

Strategy to ease geriatric history taking

A

Ask open ended questions

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12
Q

Communication strategies

A

Control the environment!

  • Well-lit room
  • Avoid backlighting
  • Minimize extraneous noise
  • Minimize interruptions
  • Consider using voice amplified device
  • Avoid multiple concurrent conversations
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13
Q

Goal of geriatric assessment

A

Promote wellness, independence

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14
Q

Focus of geriatric assessment

A

Function, performance

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15
Q

Success of geriatric assessment

A

Maintaining or improving QOL

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16
Q

Strategies for rapid screening: functional status

A

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?
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17
Q

Strategies for rapid screening: mobility

A

Get up & go

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18
Q

Strategies for rapid screening: nutrition

A

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

19
Q

Strategies for rapid screening: vision

A

Unable to read a newspaper headline with corrective lens

Snellen: unable to read greater than 20/40

20
Q

Strategies for rapid screening: hearing

A

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

21
Q

Strategies for rapid screening: cognitive function

A

3 item recall: able to remember 3 items after 3 minutes?

Clock draw test: draw proper display of face, depict correct time

22
Q

Strategies for rapid screening: depression

A

Answered YES to: Do you often feel sad or depressed or hopeless? Having little interest or pleasure in doing things?

23
Q

Complete physical assessment includes

A
  • Functional status
  • Nutrition
  • Vision
  • Hearing
  • Assessment of cognition
24
Q

Poor nutrition may reflect

A

Medical illness, depression, functional losses, financial hardship

25
Q

Frailty score: 5 criteria

A
  1. Shrinkage (unintentional wt. loss >10lbs)
  2. Weakness (decrease grip strength)
  3. Exhaustion (self-reported poor energy, endurance)
  4. Low physical activity (low energy expenditure)
  5. Slowness
26
Q

Interpretation of frailty score

A

The patient receives 1 pt for each criterion met

27
Q

0-1 points - frailty score

A

NOT frail

28
Q

2-3 points - frailty score

A

Intermediate frail (“pre-frail”)

29
Q

4-5 points - frailty score

A

Frail

30
Q

Frailty =

A

Functional decline

31
Q

How is weakness/decreased grip strength assessed? (frailty score)

A

Lowest 20th percentile by gender & BMI

Using hand-held dynamometer

32
Q

How is exhaustion assessed? (frailty score)

A

If pt reports “moderate amount of time (3-4 days)” or “most of the time” to the following two statement:

  1. I felt that everything I did was an effort
  2. I could not get going
33
Q

How is low physical activity assessed? (frailty score)

A

Minnesota Leisure Time Activities Questionnaire - lowest 20th percentile by gender:
Male <383 kcal/wk
Female <270 kcal/wk

34
Q

How is slow walking assessed? (frailty score)

A

Walking speed in the lowest 20th percentile by gender and height
Time is measured for a distance of 15 feet @ normal pace

35
Q

Common vision problems in elderly pt.

A

Cataracts, glaucoma, macular degeneration, accommodation abnormalities

36
Q

Impaired hearing can lead to

A

Depression, social withdrawal

37
Q

What do we assess first when evaluating hearing loss/difficulties?

A

Cerumen impaction

38
Q

Vision + hearing problems is related to

A

Worse outcomes

39
Q

Prevalence of Alzheimer’s disease:
___% of those 65+
___% of those 85+

A

10

50

40
Q

Memory loss is a common complaint of those with dementia - T or F?

A

False

41
Q

Cognitively impaired older persons are at increased risk for

A
  • Accidents
  • Delirium
  • Medical non-adherence
  • Disability
42
Q

What two tests does the Mini-Cog consist of

A
  1. 3 item recall (1 point for each correct word)

2. Clock draw (0 point for abnl clock, 2 for normal)

43
Q

A Mini-Cog score of __ or less suggests possible impairment

A

2

Geriatrics 1 (8 decks)

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