Geriatrics and family medicine

# 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
Helpful mnemonic: DEATH  Dressing, Eating, Ambulating, Toileting, Hygiene
Assessment tool: Katz Index of Independence in Activities of Daily Living
- 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
- Helpful mnemonic: SHAFT  Shopping, Housekeeping, Accounting, Food preparation, Transportation
- Assessment tool: Lawton Instrumental Activities of Daily Living Scale

## 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
Assessment tool: Nutritional Health Checklist
- 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
- 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
- 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)
- 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
- Useful tool: Beers criteria
- 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
- 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?"
- 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