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Flashcards in Geriatric Assessment Deck (24):
1

What do you think are some issues in geriatrics that complicate the assessment of the patient??

Elderly patients often present with: 5

1. Complex medical, psychological and social problems that have previously been managed by multiple healthcare providers

2. Long lists of medications


3. Cognitive issues
4. Hearing impairment

5. Functional disabilities NOT uncovered by the traditional history and physical!

2

Geriatric assessment should be what?
7

1. Limit background noise
2. Adequate lighting
3. Comfortable seating
4. Privacy (bring hearing aids and shut doors)
5. Face the patient and speak in a low-pitched voice
6. Providing paper and pen
7. Encourage nodding or shaking of the head

3

What should be on the problem list for a geriatric assessment?
5

1. All problems

2. Medical illnesses

3. Risk factors

4. Family History

5. Other issues
-Impacting further medical or social decision making

6. Formal diagnoses with indication of functional severity if appropriate
OA, stroke, CHF

7. Syndromic problems that require a specific therapeutic plan
Falling, instability

8. Contributory life events
Death of spouse

9. Living Circumstances
Alone
Caretaker
With family
Nursing home/Assisted living

4

Areas of Assessment and Screening? 11

1. Cognition
2. Function (ADL’s, IADL’s)
3. Mood
4. Mobility
5. Nutrition
6. Continence
7. Vision
8. Hearing
9. ETOH use
10. Caregiver
11. Social and Economic Issues

5

MMSE tests what? 5

1. Orientation
2. Registration
3. Attention and Calculation
4. Recall
5. Language

6

Describe the clock drawing test?
3

1. Instruct patient to draw a clock

2. Place hands at “20 past 8” or “10 past 11”

3. Watch change in clock over time

A technically perfect clock would be unlikely in a person with significant degree of cognitive change.

7

How do we assess function? 2

1. ADLs (Activities of Daily Living) skills needed to live at home

2. IADLs (Instrumental Activities of Daily Living) skills needed to live independently in the community

8

Basic ADL’s
6

1. Personal Hygeine
2. Dressing and undressing
3. Eating - Feeing self
4. Tranferring from bed to chair and back
5. Toileting
6. Continence

9

What scale is best indicated when functionality is a major or likely issue?
(Dementia or Chronically disabled)


Assesses what? 2

-PSMS – The Physical Self-Maintenance Scale

-Assesses need for services
-Assess level of care needed when placement is anticipated.

10

IADL’s
7

1. Obtaining and Preparing Food

2. Manage transportation
(Driving, bus schedule, taxi and Shopping, cooking)

3. Laundry

4. Housekeeping

5. Using the telephone

6. Managing Finances

7. Medication

11

IADL’s

FAQ – The Functional Activities Questionaire
Benefits? 3

1. Able to grade each function

2. Tailor to individual needs with each function

3. Can be completed by family members, home health workers, social workers

12

What test assesses Depression?

What test asseses Mobility?

1. Depression
Geriatric Depression Scale

2. Mobility
Get UP and Go test

13

What should we assess for nutrition?
3

1. WEIGHT IS A GERIATRIC VITAL SIGN!!
2. “Do you eat less than 2 meals a day?”
3. Mini-Nutritional Assessment

14

Aspects of caregivers that make them especially vulnerable to stress include.
Their own frailty? 6

1. Spouse is caregiver
2. 70 y/o caregiver to 90 y/o parent
3. ETOH
4. Depression
5. Illness
6. Caregiver demands (sandwich generation)

15

Aspects of caregivers that make them especially vulnerable to stress include.
Stressful aspect of the patient?
6

1 Disturbed nights
2. Uncontrolled aggression
3. Wandering
4. Falling
5. Uncontrolled incontinence
6. Inability to walk without assistance

16

Office Assessment
What should be included in this?
12

1. Observation of gait and balance
2. Weight, height, BMI
3. Temperature
4. Blood pressure
5. Skin
6. Eyes, ears, mouth, neck
7. Heart and chest
8. Upper extremities and hands
9. Lower extremities feet
10. Abdomen
11. Range of movement
12. CNS

17

ON PE what should we look for on skin? 4

1. Abnormal lesions
2. Pressure sores
3. Signs of trauma
4. Dry mouth and lips

18

For chest inspection on the Pe why would kyphosis be detrimental to the pt?

Pain, breathing - intrudes on lung volumes

19

What should we be assessing in the CV exam?
4

1. Rate and Rhythm
2. S3, S4
3. Murmurs
4. Carotid Bruits

20

What should we look for on the abdominal exam? 4

1. Bowel sounds
2. Fecal impaction
3. Over distended bladder
4. Finding may be subtle (Even a soft, mildly tender abdomen can mean the presence of a serious surgical disease)

21

What should we look for on GU exam? 3

What position should they be in for the pelvic exam?

1. DRE
2. Vulva for abnormalities
3. Palpable ovaries or uterus

Pelvic exam (if needed) needs small speculum and positioning on side with knees drawn up

22

Musculoskeletal exam for elderly
1. LE?
2. UE? 2

1. Lower extremities
-Gait and mobility!!!!
Get up and go test

2. Upper extremities
-Touch the back of your head with your hands
-Pick up the spoon

23

Neuro exam?
4

1. Mental status
2. Cranial nerves
3. DTR’s
4. Sensation, vibratory senses

24

Geriatric Assessment Benefits
5

1. New diagnosis
2. Fewer medications
3. Improved functional status
4. Preserving independence
5. Increased use of Home Health Services