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Flashcards in Geriatric Assessment Deck (50):
1

Define Geriatric Assessment

Multidimensional diagnostic approach to the screening & diagnosis of the physical, psychological & social impairments and the attendant functional disabilities in the frail elderly with the objective of developing an overall treatment plan which will improve the patient's QOL

2

Goals of a Geriatric Assessment

Define functional capabilities & disabilities
Evaluate the mental & emotional strengths & weaknesses
Appropriately manage acute & chronic diseases
Promote prevention & health
Establish preference for care in various situations
Understand financial resources available for care
Understand social networks & family support systems of care

3

Items Elderly Patients Present with

Complex medical, psychological & social problems that are managed by multiple providers
Long medication lists
Cognitive issues
Hearing impairment
Functional disabilities not found in a traditional H&P

4

Office Environment for the Elderly

Limit background noise
Adequate lighting
Comfortable seating
Privacy
Face the patient & speak in a low-pitched voice
Providing pen & paper
Encourage nodding or shaking of the head

5

Patient Encounter with an Elderly Person

Address patient with title & last name
Make patient the focus of attention
Direct all questions to the patient
Family may be present

6

Family Members in on an Elderly Patient's Visit

Understand that the patient should answer all questions
Can provide details about patient's illness & social situation
Assist with the treatment plan
Work as a team in achieving goals of care
Crucial to the care of patients with advanced dementia

7

Problem List in the Geriatric Population

All problems
Medical illnesses
Risk factors
Family history
Other issues

8

Things to Consider with the Problem List of a Geriatric Patient

Formal diagnosis with functional severity
Syndromic problems that require a specific therapeutic plan
Contributory life events
Living circumstances
Medications
Hx of continuing significance
Lifestyle

9

Living Circumstances

Alone
Caretaker
Family
Nursing home or assisted living

10

Hx of Continuing significance

ETOH
Tobacco use
Hysterectomy
Depression
Suicide attempt

11

Lifestyle Items of Importance

Social network
Volunteer
Do you drive?

12

Areas of Assessment & Screening in the Geriatric Population

Cognition
Function (ADLs & IADLs)
Mood
Mobility
Nutrition
Continence
Vision
Hearing
ETOH use
Social & economic issues
CAREGIVER!!!

13

Assessing Mental Status Changes

Mini mental status exam

14

Mini Mental Status Exam

Tests several areas of cognitive function
Measure of change over time
Encourage patient to make his/her best guess in response to the more factual questions

15

Parts of the Mini Mental Status Exam

Orientation
Registration
Attention & Calculation
Recall
Language

16

Define Functional Assessment

Patient is doing as much as possible physically, intellectually, socially, and being as independent as possible is a major objective of geriatric care

17

Reason for Monitoring Functional Assessment

Helps to appreciate deterioration & improvement over time

18

What is vital to properly make any medical decisions?

Knowledge of the premorbid functionality & living situation

19

Define Activities of Daily Living

Skills needed to live at home

20

Define Instrumental Activities of Daily Living

Skills needed to live independently in the community

21

Basic ADLs

Personal hygiene
Dressing & undressing
Eating
Transferring from bed to chair & back
Toileting
Continence
Communication
Visual capability
Use of the upper extremities

22

What is the physical self-maintenance scale used for?

Assesses need for services
Assess level of care needed when placement is anticipated
Most indicated when functionality is a major or likely issue

23

Instrumental Activities of Daily Living

Obtaining & preparing food
Manage transportation
Laundry
Housekeeping
Using the telephone
Managing finances
Medication

24

What is the functional activities questionnaire used for?

Determine ability to do each IADL
Able to grade each function
Tailor to individual needs with each function

25

How to check for depression in the elderly?

Geriatric depression scale

26

How to check for mobility in the elderly?

Get up and go test

27

Nutrition in the Elderly Population

Eating at least 2 meals a day
Mini-nutritional assessment

28

Checking for Continence in the Elderly Individual

Ever lose your urine & get wet?
Use depends or pads?

29

Checking for Fall Risk in Elderly Individuals

Fall & hurt yourself?
Afraid you will fall because of balance or walking problem?
Fallen 2+ times?

30

Testing for Vision Problems

Near & far vision questions
Amsler grid (macular degeneration)

31

Testing for Hearing Problems

Ear exam
Audiology screening

32

How to assess alcohol use in a geriatric patient?

CAGE questionnaire
Geriatric MAST (Michigan alcoholism screening test)

33

Why assess the caregiver?

Check for quality, skills & knowledge of caregiver essential determinants of the standard of care, potential for future care
Good caregiver = therapeutic tool
Poor caregiver = precipitates hospital or institutional placement or abuse
Ensure caregiver is not burnt out

34

Aspects of Caregivers that Make Them Especially Vulnerable to Stress

Their own frailty
Stressful aspect of the patient
Some attempt to "do everything" to alleviate guilt or prior poor relationship
Others encourage independence
Overzealous care can induce dependence

35

Contributing Factors to the Caregivers Own Frailty

Spouse is caregiver
70 y/o caregiver to 90 y/o patient
ETOH
Depression
Illness
Caregiver demands (parent & children)

36

Contributing Factors to the Stressful Aspect of the Patient

Disturbed nights
Uncontrolled aggression
Wandering
Falling
Uncontrolled incontinence
Inability to walk without assistance

37

Office Assessment of a Geriatric Patient

Baseline History
Comprehensive physical exam

38

Important Vital Signs of a Geriatric Patient

Height
Weight
BMI
BP supine & upright
Respirations

39

Important Items to Notice on Skin Exam

Abnormal lesions
Pressure sores
Signs of trauma
Dry mouth & lips

40

Important HEENT Items

Hearing
Vision
Oral mucosa
Dentition
Oral cancers
Thyroid

41

Important Chest Findings

Kyphosis & severity

42

Important Cardiac Findings

Rate/rhythm
S3, S4
Murmurs
Carotid bruits

43

What can we elicit from an abdominal exam?

Constipation
Pressure sensors of pain
Bowel sounds
Over distended bladder

44

GU Exam in the Geriatric Population

DRE
Vulva for abnormalities
Palpable ovaries or uterus

45

Musculoskeletal Exam in the Geriatric Population

Get up & go test (gait & mobility)
Have them touch the back of their head with their hands
Pick up a spoon

46

Neurological Exam in the Geriatric Population

Mental status
Cranial nerves
DTRs
Sensation, vibration senses

47

Preference for Care

Explore patients values
Ask about advanced directives

48

Office Assessment Over Time

One medication adjustment at a time
Observe target symptoms & effectiveness
Allows growing familiarity with capacity & capability of patient & family

49

Benefits to a Geriatric Assessment

New diagnosis
Fewer medications
Improved functional status
Preserving independence
Increased use of home health services

50

4 Parts to a Geriatric Plan

Therapeutic interventions
Health maintenance
Rehabilitative techniques
Patient & family education