Geriatric Health Assessment Flashcards
Five areas to focus on function
- Physical
- Social
- Psychological
- Cognitive
- Environment
Challenges to Geriatric Health Assessment
- Communication
- Underreporting of symptoms: afraid of hospital, nursing homes, not being able to care for selves anymore à minimize
- Vague or non-specific complaints: “More tired than normally am” - ? is it normal aging or HF?
- Atypical presentation of common clinical problems: e.g. her pt that had unilateral weakness, neuro symptoms, didn’t want interventions e.g. CT/MRI. Looked around and found UTI. Treated her and all neuro Sx subsided.
- Multiple coexisting illnesses
- Cognitive impairment: family member helpful
IZs
Influenza, Pneumococcus, Herpes zoster, Td
lab to review at every visit
calculated creatinine clearnance - esp if on a lot of meds!
Good resource for meds in geriatric population
http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2012
Beer’s Criteria
General symptoms may indicate treatable underlying disease
- Fatigue
- Anorexia
- Weight loss
- Insomnia
- Continence
- Mood
- Memory
- Pain
- Mobility problems
- Recent change in functional status
- Falls: big one – all the sudden falling, often an underlying issue
Common physical findings: vital signs
Elevated BP
Postural changes in BP
Irregular Pulse
Tachypnea
Weight changes
ADLs
(personal needs)
FEED
TOILET
DRESS
GROOM (hair, nails, makeup, shaving, oral care, clothing))
TRANSFER
AMBULATE (walk inside; outside)
BATHE OR SHOWER
climb stairs
maintain posture
change position in bed/chair
climb stairs
sleep
communicate
sex
IADLs
(household needs) “Instrumental ADLs”
USE TELEPHONE (summon help in an emergency)
SHOP (groceries, supplies)
PREPARE FOOD
HOUSEKEEPING (cleaning, garbage disposal)
LAUNDRY
TRANSPORTATION
TAKE MEDICINES
MANAGE MONEY
pet care
home maintenance (repairs, lawn care, snow removal)
self-care: medical needs
loss in ADLs vs IADLs
IADLs tend to go first. Loss of ADLs really concerns us
Assessing gait speed
- Measure a standard distance (e.g., 20 feet) and place markers at the start and finish.
- Start the patient 5 feet in front of the mark and have the patient walk 5 feet past the finish mark.
- Begin the stopwatch as soon as the person’s foot crosses the start line and stop recording when the person’s second foot crosses the finish line.
- Have the person perform 3 repetitions of each condition and calculate the average time
- Ask the patient to walk at his/her preferred walking speed. Instruct the patient to continue walking 5 feet beyond the finish line.
- Ask the patient to walk as quickly as possible, but safely. Instruct the patient to continue walking 5 feet beyond the finish line.
- <1.9 ft./sec = would benefit from PT eval and possible treatment
Assessing mobility
Timed Up and Go:
- Arms folded across chest
- Rise from chair
- (use cane or walker if needed)
- Walk 10 feet, turn, walk back, sit down
- Normal : < 10 sec; Further assessment: > 20 sec
Comprehensive functional assessment
- Performance oriented mobility assessment (Tinetti Gait and Balance Scale)
- http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/poma.pdf
- Full musculoskeletal and neurological examination
What would lead you to perform a comprehensive nutritional assessement?
- lost more than 10 lbs. in the past 6 months without trying to do so?
- Is Body Mass Index < 20?
- Yes to either
nutritional assessment tools
- Mini Nutritional Assessment:
- http://consultgerirn.org/uploads/File/trythis/issue_9.pdf
- Nutritional Screening Initiative: DETERMINE
- http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/determine.pdf
- 24-hour recall or food diary
- Albumin/prealbumin
cognitive assessment tools
- Mini-Cog
- http://consultgerirn.org/uploads/File/trythis/issue03.pdf
- 3-item recall
- If unable to remember all 3 after one minute, more comprehensive testing
- Name as many four legged animals as possible in one minute (> 8 –10)
- Clock drawing
- Ask common knowledge questions
- Major events, i.e. election, 9/11
Mental status assessments
folstein MMSE, SLUMS
consider educational level or other confounding factors!
Geriatric Assessment: Depression Screening
- Ask:
- “Do you often feel sad or depressed?”
- Geriatric Depression Scale –short form [GDS-15]
- http://www.stanford.edu/~yesavage/GDS.html
- SIG-E-CAPS
- Change in Sleep or sexual activity
- Decreased Interest in activities
- Increased feelings of Guilt or remorse
- Decreased Energy
- Difficulty Concentrating
- Change in Appetite
- Psychomotor increase or decrease
- Thoughts of Suicide
- Helplessness or hopelessness
- Apathy or self-neglect
- Irritability
Advanced Directives
- Living Will
- Healthcare proxy
- “Five Wishes” 10 page legal document – what you want at end of life
- http://www.agingwithdignity.org/5wishes.html
- Ongoing discussion
actinic purpura
purple patches or macules on skin that fade over time. Come from blood that has leaked through poorly supported capillaries and spread wi/in the dermis
Assessing vision & hearing
included in 10-minute geriatric screener
eye chart, asking about hearing loss + whisper voice test if necessary
When to screen
take into acct years left & whether diagnosis would prolong or improve life
Frailty screening
3 of 5 central components ID’d in CV Health Study
- unitentional weight loss,
- slow walking speed,
- self-reported exhaustion,
- low energy ependiture,
- weakness
ETHNIC(S) pneumonic
escape pitfalls of group labeling / provide more culturally relevant assessments:
* E Explanation (How do you explain your illness?) T Treatment (What treatment have you tried?) H Healers (Have you sought any advice from folk healers?) N Negotiate (mutually acceptable options) I (Agree on) Intervention C Collaboration (with patient, family, and healers)
(S Spirituality)
may miss important info about cultural identity, social supports, views about health care
Experts recommend letting patients establish their cultural identity by probing 4 key areas during patient interview:
- individual’s cultural identity
- cultural explanations of the individual’s illness,
- cultural factors related to psychosocial environment and levels of function,
- cultural elements in clinicial patient relationship
