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Flashcards in Geriatric Health Assessment Deck (63)
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1

Five areas to focus on function

  • Physical
  • Social
  • Psychological
  • Cognitive
  • Environment

2

Challenges to Geriatric Health Assessment

 

  • Communication
  • Underreporting of symptoms: afraid of hospital, nursing homes, not being able to care for selves anymore à minimize
  • Vague or non-specific complaints: “More tired than normally am” - ? is it normal aging or HF?
  • Atypical presentation of common clinical problems: e.g. her pt that had unilateral weakness, neuro symptoms, didn’t want interventions e.g. CT/MRI. Looked around and found UTI. Treated her and all neuro Sx subsided.
  • Multiple coexisting illnesses
  • Cognitive impairment: family member helpful

3

IZs

Influenza, Pneumococcus, Herpes zoster, Td

4

lab to review at every visit

calculated creatinine clearnance - esp if on a lot of meds!

5

Good resource for meds in geriatric population

http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2012

Beer's Criteria

6

General symptoms may indicate treatable underlying disease

 

  • Fatigue
  • Anorexia
  • Weight loss
  • Insomnia
  • Continence
  • Mood
  • Memory
  • Pain
  • Mobility problems
  • Recent change in functional status
  • Falls: big one – all the sudden falling, often an underlying issue

7

Common physical findings: vital signs

Elevated BP
Postural changes in BP
Irregular Pulse
Tachypnea
Weight changes

8

ADLs

(personal needs)

FEED
TOILET
DRESS
GROOM (hair, nails, makeup, shaving, oral care, clothing))
TRANSFER
AMBULATE (walk inside; outside)
BATHE OR SHOWER
climb stairs
maintain posture

 


change position in bed/chair
climb stairs
sleep
communicate
sex

9

IADLs

(household needs) "Instrumental ADLs"

USE TELEPHONE (summon help in an emergency)
SHOP (groceries, supplies)
PREPARE FOOD
HOUSEKEEPING (cleaning, garbage disposal)
LAUNDRY
TRANSPORTATION
TAKE MEDICINES
MANAGE MONEY
pet care
home maintenance (repairs, lawn care, snow removal)
self-care: medical needs

 

10

loss in ADLs vs IADLs

IADLs tend to go first. Loss of  ADLs really concerns us

11

Assessing gait speed

  • Measure a standard distance (e.g., 20 feet) and place markers at the start and finish.
    • Start the patient 5 feet in front of the mark and have the patient walk 5 feet past the finish mark.
    • Begin the stopwatch as soon as the person’s foot crosses the start line and stop recording when the person’s second foot crosses the finish line.
    • Have the person perform 3 repetitions of each condition and calculate the average time
  • Ask the patient to walk at his/her preferred walking speed. Instruct the patient to continue walking 5 feet beyond the finish line.
  • Ask the patient to walk as quickly as possible, but safely. Instruct the patient to continue walking 5 feet beyond the finish line.
  • <1.9 ft./sec = would benefit from PT eval and possible treatment

12

Assessing mobility

Timed Up and Go:

  • Arms folded across chest
  • Rise from chair
  • (use cane or walker if needed)
  • Walk 10 feet, turn, walk back, sit down
  • Normal : < 10 sec; Further assessment: > 20 sec

13

Comprehensive functional assessment

  • Performance oriented mobility assessment (Tinetti Gait and Balance Scale)
  • http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/poma.pdf
  • Full musculoskeletal and neurological examination

14

What would lead you to perform a comprehensive nutritional assessement?

  • lost more than 10 lbs. in the past 6 months without trying to do so?
  • Is Body Mass Index < 20?
  • Yes to either

15

nutritional assessment tools

  • Mini Nutritional Assessment:
  • http://consultgerirn.org/uploads/File/trythis/issue_9.pdf
  • Nutritional Screening Initiative: DETERMINE
    • http://www.hospitalmedicine.org/geriresource/toolbox/pdfs/determine.pdf
  • 24-hour recall or food diary
  • Albumin/prealbumin

16

cognitive assessment tools

  • Mini-Cog
  • http://consultgerirn.org/uploads/File/trythis/issue03.pdf
  • 3-item recall
    • If unable to remember all 3 after one minute, more comprehensive testing
  • Name as many four legged animals as possible in one minute (> 8 –10)
  • Clock drawing
  • Ask common knowledge questions
    • Major events, i.e. election, 9/11

17

Mental status assessments

folstein MMSE, SLUMS

consider educational level or other confounding factors!

18

Geriatric Assessment: Depression Screening

  • Ask:
    • “Do you often feel sad or depressed?”
  • Geriatric Depression Scale –short form [GDS-15]
    • http://www.stanford.edu/~yesavage/GDS.html
  • SIG-E-CAPS
    • Change in Sleep or sexual activity
    • Decreased Interest in activities
    • Increased feelings of Guilt or remorse
    • Decreased Energy
    • Difficulty Concentrating
    • Change in Appetite
    • Psychomotor increase or decrease
    • Thoughts of Suicide
  • Helplessness or hopelessness
  • Apathy or self-neglect
  • Irritability

19

Advanced Directives

  • Living Will
  • Healthcare proxy
  • “Five Wishes”  10 page legal document – what you want at end of life
    • http://www.agingwithdignity.org/5wishes.html
  • Ongoing discussion

20

actinic purpura

purple patches or macules on skin that fade over time. Come from blood that has leaked through poorly supported capillaries and spread wi/in the dermis

21

Assessing vision & hearing

included in 10-minute geriatric screener

eye chart, asking about hearing loss + whisper voice test if necessary

22

When to screen

take into acct years left & whether diagnosis would prolong or improve life

23

Frailty screening

3 of 5 central components ID'd in CV Health Study

  • unitentional weight loss,
  • slow walking speed,
  • self-reported exhaustion,
  • low energy ependiture,
  • weakness

24

ETHNIC(S) pneumonic

escape pitfalls of group labeling / provide more culturally relevant assessments:

  • E Explanation (How do you explain your illness?)
    T Treatment (What treatment have you tried?)
    H Healers (Have you sought any advice from folk healers?)
    N Negotiate (mutually acceptable options)
    I (Agree on) Intervention
    C Collaboration (with patient, family, and healers)

(S Spirituality)

may miss important info about cultural identity, social supports, views about health care

25

Experts recommend letting patients establish their cultural identity by probing 4 key areas during patient interview: 

  • individual's cultural identity 
  • cultural explanations of the individual's illness,
  • cultural factors related to psychosocial environment and levels of function,
  • cultural elements in clinicial patient relationship

26

Ethnogeriatric IQ

Can be assessed at Stanfor Geriatrics Education Center Web site

27

screening for colorectal cancer

through 75yo

recommends against 76-85yo

28

PSA screen, USPTF

insufficient evidence to balance benefits & harms for <75yo

Recommends against for >75yo

29

skin & lung ca, USPTF

insufficient to recommend for or against whole body skin exams or screenings for lung ca

30

age-related cognitive decline 

suggested by mild forgetfulness, difficulty rememering names, mildly reduced concentration. Sporadic & do not affect function