Geriatric Assessment Flashcards
Principle of the Comprehensive Geriatric Assessment (CGA)
goal = promote wells and independence while identifiying subtle things
Scope: physcia, cognitive, psych and social
approach: interdis.
efficiency: apid to perform rapid screenign to find target areas
success: to improve QOL
things to do to ensure success in the assessment
- adqeuate lighting, minimize background nosie
- confrim pt. hearing aids, dentures and glasses are in
- maximized provider=pt. relationship
Components of the CGA
Functional statu; this is ADLs, & iADls & mbility
Cognitive status
Medical problems
Geratric Syndromes: incont. falls, uclers, etc.
Medication
Nutrtion
Social issues: financial anduspport
Affective Status
Functional Status: the CGS
waht does it include
why does it matter
Functional Status: mobility, ADLs, iADLS, etc.
this is a measure of the paitnets health in the context of environemetn and social support
want to assess at..
- first sigth of disease or deconditioning
- assist them in proper expectations of goals in thearpy
- prevoide prognosis
- monitor chronic and acute illnesses
FUnctional Status: ADL and iADLs measures
Activities of Daily Living: (ALDs)
- basic self care needs
- inabiity to perform ADLS signifies the need for higher level of care
Instrumental ADLs (iADLs)
- higher level activities that individuasl must perform or get help with to remain independent
- phones, laundry, cooking, meds, finances, etc.
pt. = over report & families underreport
must assess at every new pt. visit and continuous with old pt.
Functional Staus: Mobility Assessment tools
Gait speed
- time pt. ability to walk 4 meters
- > 13 seconds: increased risk of falls
- risk for falls, frality and surivial
Muslce Strength
- asses quad strength by observing them rising from a hair without pushing off
- inabiltiy to do this suggests weakness and associated with hip fx. and frality and falls
- used in freid fraility assessment
Timed up and Go test
- pt. rises from chair, walks then sits down
- tests muscle strength and speec together in one test
- deficiency in this test suggests risk of falls
_______________________
Falls are RARELy just a fall
- all frail adults need to be asekd at each visit about falls
- all older adults should be asked if they have fallen at least annually
inspect
- gait/mobility
- orthostatic hypotension
- med revei
- foot inspection
- balance testing
Cogntion: the CGA
the 3 Ds: Depression
Screening
- USPSTF say screen if you have tools in place to help assist
- AgeriS: scren for depression when you screen for dementia
Screenig Tools
- geriatric depression scale: easiest to use & most widely accepted
- PHQ2: can be good but geratirc is better and comprhensive for this pop
Cognition: the Mini Cog
Cognition
- the first tool to assess cognition is the mini-cog
effective triage tool to identify pt. in need of a more through eval. (with MMSE and MOCA)
- highly sensitive for predicting dementia
- short, 3 minute test
- clock draw is vital information that can be tracked over time
what is it
- three workd recognition
- clock draw
- three word recall
Cognition: the MMSE
MMSE: mini-mental status exam
most widely used tool for detecting dementia is the US
waht is it
- 7 minute test of orientation, recall, attention, calculation, language and construction
limitationg
- this test is NOT sensitive for mild dementia
- can be influenced by age and education and lanaguage
score of < 24 + functional impairment = suggests dementia
(wihtout functional ipaorment = mild cog. impairement)
Cognition: the MoCA
MoCA: 10 minutes
more sensitive for predicting mild congitive impairment
downside
- less able ot be used with those of lower educational background, may need to score adjust
score of < 26 + functional impairment = dementia likely
moca includes a mini trails test
Scores
- mild = 18-25
- moderate = 10-17
- severe = < 10
Trails testing
what is it
indicates what
Trails testing
A and B
B = indicates ability to drive (suggestive) due to higher executive function needed
timed ability to connected the dots in order with numbers and letters
a mini trails is within the MoCA test
Multi-Complexitiy : Geriatric Syndromes
Sleep
Geriatric Syndromes: things which are multifaced disease/symptoms/occurances which are the result of accumulated effects of impairements in the individuals abilities’ indicatin gVulerabiltiy and challeneges
Sleep disorders
- difficult to fall asleep , but insomnia presentation is less common in older adults & difficult to obtain restful sleep
Consider iatrogenic influences of disordered sleep (MEDS!!)
Treatment
- CBT-I is the first choice for chronic insomina
- beware of meds!!!
- benzo’s actaulyl shorten REM
Geriatric Syndrome: Urinary Incontience
UI: common in those > 80 and younger too
-much more common in assisted living and long-term care: #1 reason for institutionalization to a nursing home
Causes
- medical complications: cellulist, ulcers, UTIs, etc.
- nocturia: falls & sleep deprivation
- mental health! anxiety and depression
Genetic Syndromes: Pressure Uclers
Pressure Ulcers
- localized injury to skin and underlying tissue usually voer boney prominences
- highest in hospitals (incidence)
- higest in LTCF (prevelence)
Stage 1
- errythema but SKIN INTACT
Stage 2
- skin broken, exposed but the adipose tissue not showing
Stage 3
- skin broken, adipose tissue exposed
Stage 4
- skine exposed, adipose and bone, ligmanet, etc. espoed
once something is labeled at its highest grade it will not revert to lower, you do not regrade down (only up)
Medication Management: CGS
Polypharm
- unnecessary medications (under or over)
- commonly > 5/9
- 10+ excessive polypharm
- the average elderly is on 4+ meds, 5+ = 29% and a big chunck are inappropriate
- hospitalizaion increased number of med!!
why it maters
- taking meds (especially 5+) is hard to do and remeber
- meds are $$$
- meds have side-effects
- there are non-pharm optiosn which may help
- always search to deperscribe
Malnutrition: CGA
71% of older adults in hospital are at nutrtional risk or malnutrition
- involuntary weight loss = increased risk of mortality
Treatment
- address underlying SES, psych or psyiologica changes) of aging
- encourage deitary cahnges
- focus on whole foods > supplements
