Geriatrics and family medicine
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Geriatric Assessment
Overview
- The geriatric assessment is a multidisciplinary evaluation of an elderly individual's functional status, physical health, cognition, mental health, social support system, and home environment
- A complete review of all medications, supplements, vitamins and immunization status should occur are essential components of a geriatric assessment
- Changes in health or functional status, including confusion, falls, immobility, or incontinence, in a geriatric patient should prompt a complete geriatric assessment
Functional status
- Assess the individuals ability to perform activities of daily living (ADLs) and intrinsic activities of daily living (IADLs)
- ADLs are the self-care activities that a person must be able to perform on a daily basis to maintain their health and well-being
- Helpful mnemonic: DEATH → Dressing, Eating, Ambulating, Toileting, Hygiene
- Assessment tool: Katz Index of Independence in Activities of Daily Living
- IADLs are the activities that enable an individual to live independently within a community
- Helpful mnemonic: SHAFT → Shopping, Housekeeping, Accounting, Food preparation, Transportation
- Assessment tool: Lawton Instrumental Activities of Daily Living Scale
- ADLs are the self-care activities that a person must be able to perform on a daily basis to maintain their health and well-being
Physical health
- In general, the assessment should include common geriatric disorders and complications such as:
- Malnutrition → vitamin A, vitamin C, vitamin D, vitamin B12, calcium, iron, zinc
- Assessment tool: Nutritional Health Checklist
- Visual changes → presbyopia, macular degeneration, cataracts, diabetic retinopathy
- Hearing loss → presbycusis
- Assessment tools: Screening Version of the Hearing Handicap Inventory for the Elderly and Whispered Voice Test
- Urinary incontinence → urge incontinence, overflow incontinence, stress incontinence, functional incontinence
- Screening questions: "Do you have a strong and sudden urge to void that makes you leak before reaching the toilet?" = urge incontinence; "Is your continence caused by coughing, sneezing, lifting, walking, or running?" = stress incentinence
- Imbalance/falls
- Screening test: Tinetti Balance and Gait Evaluation; simplified version = timed get up and go test
- Decrease fall risk through exercise (especially Tai Chi), physical/occupational therapy, home hazard assessment, and discontinuing medications that may contribute to dizziness or lightheadedness (psychotropic agents, anticholinergics, overly aggressive hypertension management)
- Osteoporosis
- Polypharmacy
- Useful tool: Beers criteria
- Malnutrition → vitamin A, vitamin C, vitamin D, vitamin B12, calcium, iron, zinc
- Screening for early detection of treatable malignancies and diseases (diabetes mellitus, hypertension, hyperlipidemia) should be considered in all geriatric patients
- The potential harms and benefits of screening, patient preferences, and overall prognosis should be considered
- Assessment tool: Electronic Preventive Services Selector
Cognition/mental health
- Screen all geriatric patients for depression
- Assessment tools: Geriatric Depression Scale, Hamilton Depression Scale or two question screen or "During the past month have you been bothered by feelings of sadness, depression, or hopelessness?" and "Have you often been bothered by a lack of interest or pleasure in doing things?"
- Screen for early dementia using the Mini-Cognitive Assessment Instrument
References
- Elsawy B, Higgins KE. The Geriatric Assessment. Am Fam Physician. 2011;83(1): 48-56.