Geriatric Assessment Flashcards
(43 cards)
What should you do prior to appt w/ geriatric pt.?
Review pt’s medical record - lengthy!
What else can you implement to help you maximize your time during an appt w/ a geriatric pt?
Pre-clinic review of systems questionnaire
In geriatric pt. it is important to focus on ________ needs in addition to medical needs
Bio-psycho-social
Unique features of geriatric pt
- Complexity of disease
- Altered response or organ systems
- Chronicity of illness
- Severity of acute illness & slower recovery
- Functional impairments limited independent ADLs
- Fragility (emotional, physical, socioeconomic) of response to illness, intervention, and stress
- Unstable economic & social supports
- Limitation in reversibility of impairments: rehab > cure
Special ROS Considerations
- Cognitive impairment
- Dental status
- Falls
- Foot disorders
- Gait abnormalities
- Hearing loss
- Incontinence
- Nutrition or feeding impairment
- Osteoporosis
- Pressure ulcers
- Psychiatric illness
- Sexual history
- Sleep disorders
- Vision loss
What makes older adults vulnerable?
- Chronic health conditions
- Physical, sensory, cognitive impairments
- Psychological & social factors (health & safety)
- Accessibility, equity, & social determinants
- Finances & family caregiver considerations
The ______________ is a paradigm for approaching older patients who have complex bio-psycho-social needs
WI Star Method
The Wisconsin Star Method takes into account what 5 factors when addressing a patient’s problem or symptoms
Social, medication, medical, behavioral, personal
____________________ is an organizational approach to caring for people with chronic disease in a primary care setting that creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team
Wagner’s Chronic Care Model
Issues in geriatric history taking
- Underreporting of illness
- Illness viewed as normal sign of aging
- Accepting illness as inevitable
- Patient intimidated by busy practitioner
- Denial of illness
- Patient cannot afford to seek care
- Patient fears consequences of reporting sx (test, medication)
- Atypical, nonspecific presentation of illness
- Communication barriers
- Extensive w/ multiple problems
Strategy to ease geriatric history taking
Ask open ended questions
Communication strategies
Control the environment!
- Well-lit room
- Avoid backlighting
- Minimize extraneous noise
- Minimize interruptions
- Consider using voice amplified device
- Avoid multiple concurrent conversations
Goal of geriatric assessment
Promote wellness, independence
Focus of geriatric assessment
Function, performance
Success of geriatric assessment
Maintaining or improving QOL
Strategies for rapid screening: functional status
Answered YES to (1 or more): Because of a health or physical problem, do you need help to
- Shop?
- Do light housework?
- Walk across a room?
- Take a bath or shower?
- Manage the household finances?
Strategies for rapid screening: mobility
Get up & go
Strategies for rapid screening: nutrition
Answered YES to: Have you lost more than 10lb over the past 6 months without trying to do so OR do you have a BMI of <20kg/m2
Strategies for rapid screening: vision
Unable to read a newspaper headline with corrective lens
Snellen: unable to read greater than 20/40
Strategies for rapid screening: hearing
Handheld audioscope, whisper test
- Unable to hear a 40dB tone at 1000 or 2000 Hz in both ears or at either frequency in one ear
Strategies for rapid screening: cognitive function
3 item recall: able to remember 3 items after 3 minutes?
Clock draw test: draw proper display of face, depict correct time
Strategies for rapid screening: depression
Answered YES to: Do you often feel sad or depressed or hopeless? Having little interest or pleasure in doing things?
Complete physical assessment includes
- Functional status
- Nutrition
- Vision
- Hearing
- Assessment of cognition
Poor nutrition may reflect
Medical illness, depression, functional losses, financial hardship
