Module 1 (a) - Principles Of Geriatric Assessment

Question 1

Rapid Screening Strategies

-Functional Status Questions?

Answer 1

Answer “YES” to one or more of the following questions? Because of health or physical problem, do you need help to:

1. Take bath or shower?
2. Walk across a room?
3. Prepare meals?
4. Manage medications?
5. Manage household finances?

Question 2

Rapid Screening Strategies

-Mobility

Answer 2

1. “Timed get up and go” test: unable to complete in <15 seconds
   - Usual gait speed: unable to walk 50 ft in <20 seconds

Question 3

Rapid Screening Strategies

-Nutrition

Answer 3

1. Unintentional weight loss of >/=5% in prior 6 months or BMI <20 kg/m2

Question 4

Rapid Screening Strategies

-Vision

Answer 4

1. If unable to read a newspaper headline and sentence while reading corrective lenses, test each eye with Snellen chart
   - Unable to read greater than 20/40

Question 5

Rapid Screening Strategies

-Hearing

Answer 5

1. Acknowledges hearing loss when questioned or unable to perceive a letter/number combination whispered at a distance of 2 feet

Question 6

Rapid Screening Strategies

-Cognitive Function

Answer 6

1. 3-item recall: Unable to remember all 3 items after 1 minute
2. Mini-cog: recall = 0 or recall <3 and abnormal clock

Question 7

Rapid Screening Strategies

-Depression

Answer 7

Answer “YES” to either of the following: In the past month have you often been bothered by

1. Feeling down, depressed, or hopeless?
2. Having little interest or pleasure in doing things?

Question 8

Rapid Screening Strategies

-Tips

Answer 8

1. Efficient Strategies need to be incorporated in geriatric assessments
   - Rapid screening of targeted areas
   - Train office staff
   - Rolling assessment - target at least one area for screening during each office visit

Question 9

Welcome to Medicare Visit

-Components

Answer 9

1. New beneficiaries get a preventative exam w/out a copayment w/in one year of beginning coverage
2. Review medical and social hx + education and counseling about preventive services
   - Screenings — flu, pneumococcal shots, and other referrals
   - Height, weight, and BP, BMI
   - Simple vision test
   - Review risk for depression & level of safety
   - Introduction to creating advance directives
   - Written plan for screenings, shots, and other Preventive services

Question 10

Annual Wellness Visit

-Components

Answer 10

1. Provided at no cost to beneficiaries, including those w/ Medicare advantage or fee-for-service coverage
2. Assessment and documentation of functional status, nutrition, cognitive impairment, depression, and other components of geriatric assessment are required

Question 11

Functional Status Tools

Answer 11

1. Gait Speed - STRONGEST predictor of future disability and death **

Question 12

Quality of Life

-Ways to Assess?

Answer 12

1. How would you rate your overall quality of life at the present time?
   - Would you say it is excellent, very good, good, fair or poor
2. Thinking only about your health, how would you rate the quality of your life at the present time?
   - Would you say it is excellent, very good, good, fair or poor?

Question 13

Advanced Care Planning

-Goal

Answer 13

1. The goal of Advanced care planning is to help ensure that people receive medical care that is consistent w/ their values, goals, and preferences during serious and chronic illness. **
2. ACP is successful when delivered care aligns w/ patients goals
3. ACP is most effective when it takes place BEFORE it is needed, before the person, for whatever reason, has lost decision-making capacity

Question 14

Advanced Care Planning

-Documentation

Answer 14

1. Document “GIST of conversation” involving goals, values, and priorities. Make sure these are captured for later reference

Question 15

Summary Of Older Adult Care? **

Answer 15

1. The focus of geriatric assessment is on quality of life and function
2. Successful assessment promotes wellness and independence
3. Strategies that enhance communication w/ older patients should be used
4. Rapid screening strategies are available and should be utilized
5. Comprehensive assessment includes, physical, cognitive, psychological, and social aspects of health
6. Advanced care planning is a process that captures evolving conversations taking place over time, not a “one and done” event
   - Discussions should be revisited w/ any change in health status or life transitions