Geriatrics SC049: Comprehensive Geriatric Assessment And Rehabilitation In Older People

Question 1

Comprehensive geriatric assessment

Answer 1

aka Multidisciplinary geriatric assessment

Definition:
- Multidimentional, interdisciplinary diagnostic process intended to determine a frail elderly person **medical, **psychosocial, ***functional capacities and problems with the objective of developing an overall plan for treatment and long-term follow-up

Benefit:
1. Lower mortality
2. Less acute hospital stay
3. Less likely to be discharged to nursing homes
4. Improve in morale + functional status
5. Less direct cost of institutional care

Question 2

Characteristics of elderly people

Answer 2

• Multiple organic, psychological, social problems
• Functional and physiological capacities diminished
• Adverse effects of drugs pronounced
• Physical diseases might present as mental disorder e.g. delirium, confusion
• Atypical presentation in S/S e.g. silent MI (present as dyspepsia / dizziness)
• Frail, Pre-frail common
• Sarcopenia

Chronic diseases:
1. HT
2. DM
3. Arthritis
4. Eye diseases
5. High cholesterol
6. Heart diseases
7. Osteoporosis
8. Diseases of ENT
9. Respiratory diseases
10. Stroke

Question 3

***Domains of elderly for assessment

Answer 3

1. ***Physical health
2. ***Mental function: Cognitive + Psychiatric symptoms
3. ***Functional: Basic ADL + Instrumental ADL
4. Social resources
5. Environmental resources
6. Economic resources

Question 4

***Basic structure of Comprehensive geriatric assessment

Answer 4

1. Multidisciplinary approach
2. Utilisation of >=1 set of ***measuring instruments
3. Use of ***interdisciplinary team
4. Attempt to couple assessment with ***intervention programme e.g. rehabilitation, counselling, placement
5. Flexibility is the rule to gear towards the need of a particular setting, purpose, society

Purpose:
1. Diagnostic work-up to develop treatment plan
2. Monitoring of progress
3. Screening for early detection of potential disability
4. Determining level / setting of long-term care required by a patient (e.g. institutions)
5. Education + Research

Question 5

Common members of multidisciplinary team

Answer 5

1. Geriatricians
2. Nurses
3. PT —> e.g. walking rehabilitation
4. OT —> e.g. home visit with home modification, ADL training
5. Dietitian
6. Speech therapist
7. Podiatrist
8. MSW —> e.g. approve disability allowance

Question 6

Geriatric assessment instruments

Answer 6

Purpose:
1. Make process of assessment easy to perform and teach
2. More reliable
3. Facilitate transmission of understandable and standardised clinical information between health providers, permitted smooth team work to occur, meaningful, valid data to be tabulated
4. Therapeutic progress to be measured over time

Tools:
1. Basic ADL
- ***Barthel index (20 / 100)
- Functional Independence Measure (FIM) (full score: 126)

2. Instrumental ADL
   - ***Lawton IADL scale
3. Advanced ADL (include recreational, occupational, community services function)
4. Motor function
   - Elderly Mobility Scale (EMS) (full score: 20)
   - Berg Balance Scale (BBS) (full score: 56)
   - **Timed Up and Go test (TUGT)
   —> **>=15 seconds (related to post-op complications and 1 year mortality) (SC047)
   —> ***<10s: Normal
   - Tinetti Balance and Gait evaluation
5. Cognitive
   - **Abbreviated Mental Test (AMT) (10 domains: 0-3 severe, 4-7 moderate impairment, 8-10 normal) (ONLY a **screening tool, NOT diagnostic)
   - C-MMSE (Chinese MMSE)
   - ***Montreal Cognitive Assessment (MoCA)
   - Clock drawing test
6. Sarcopenia
   - SAR-C
7. Frailty
   - Fried’s phenotypic frailty
   - Frailty index
   - Rockwood Clinical Frail Scale
   - Morley: FRAIL scale
8. Depression
   - ***Geriatric depression scale (GDS4 / 15 / 30)
   - Hamilton rating scale for depression
   - Selfcare (D)
   - Zung self-rating depression scale
9. Socioeconomic