L7: ASSESSMENT IN THE ELDERLY

COMPREHENSIVE GERIATRIC ASSESSMENT

Multidimensional, interprofessional, diagnostic process to identify care needs, plan care, and improve outcomes for older people

COMPREHENSIVE GERIATRIC ASSESSMENT

An evaluation designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/ or institutionalization and enable them to live independently for as long as possible

Physical health

These dimensions belong to what domain

• History taking

• Physical examination

• Diagnostics

• Nutritional assessment

• Medication review

Functional health

These dimensions belong to what domain

• Activities of daily living

• Instrumental ADLs

• Sensory assessment (hearing, vision)

• Gait and balance

Psychological health

These dimensions belong to what domain

• Cognitive disorders (delirium, dementia, mild cognitive impairment)

• Affective disorders (depression, anxiety)

• Spiritual well-being

Socioenvironmental supports

These dimensions belong to what domain

• Social network and support

• Living situation

• Environmental safety

• Economic resources

Quality of life measures

These dimensions belong to what domain

• Physical conditions

• Social conditions

• Environmental conditions

• Personal resources (mental health, life perspective)

• Preferences for care

• Memory loss

• Confusion

• dementia

A request for a geriatric assessment would be appropriate when there are persistent or intermittent symptoms such as:

• ?

• ?

• Or other signs of possible ?

diffuse

When doing geriatric assessment, you must use ? lighting with increased illumination, and avoid directional or localized light

glossy, polished

When doing geriatric assessment, you must avoid ? or highly ? surfaces, including floors, walls, ceilings, and furnishings.

mental status exam

If the patient's responses to initial questions are clearly inappropriate, turn to the ? immediately

Katz Index of Independence in Activities of Daily Living

• tool used to screen for basic functional activities of older patients if he/ she can still perform

ADLs

self-care activities that a person performs daily (eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions)

Lawton IADL Scale

• tool used to check if older patients can do the IADL that are needed to live independently (doing housework, preparing meals, taking medications properly, managing finances, using a telephone)

Nutritional health Checklist and Mini Nutritional Assessment

• assessment used to identify older adults who have or are at risk for malnutrition.

Tinetti’s Performance Oriented Mobility Assessment

Hearing Handicap Inventory for the Elderly

• tool that accurately identify persons with hearing impairment

Mini Mental Status Examination

Mini-Cog

• shorter than the MMSE and measures executive function 

• composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer

Montreal Cognitive Assessment (MoCA), and Saint Louis University Mental Status Examination (SLUMS)

• tools that are better at identifying mild neurocognitive disorder and are available online; unlike the MMSE, which is copyrighted

Confusion Assessment Method (CAM)

• tool that takes 5 minutes to administer (Inouye et al., 1990)

• instruments designed to screen for delirium