Here are the key steps in assessing cognition in older adults:
1. Use a standardized cognitive screening tool like the Mini-Mental State Examination (MMSE) or Mini-Cog to evaluate various cognitive domains including orientation, memory, attention and language.
2. Observe the patient's behavior and mood, looking for signs of depression, anxiety or other psychological issues that can impact cognition.
3. Get input from a family caregiver regarding any changes in the patient's cognitive or functional abilities.
4. Refer for neuropsychological testing if indicated based on screening results or concerns about specific impairments like memory problems.
5. Consider reversible causes of cognitive decline like medications, metabolic abnormalities, infections and discuss
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Comprehensive Geriatric assessment
1.
2. A multidisciplinary diagnostic process
intended to determine a frail older person’s
medical, functional, and psychosocial status
and limitations in order to develop a plan for
treatment and long-term follow-up.
3. Physician
Nurse Practitioner or Physician Assistant
Nurse
Social Worker
Physical/Occupational/Speech /psychological
Therapist
Pharmacist
Dietician
Dentist
Each member of team sees every
patient
4.
5. Highest priority:
Prevention of decline in the independent
performance of ADLs
Drives the diagnostic process and clinical decision
making
Screen for preventable diseases
Screen for functional impairments that may result in
physical disability and amenable to intervention
6. Improve diagnostic accuracy
Guide selection of interventions to restore or
preserve health
Recommend optimal living environment
Monitor clinical change over time
Predict outcomes
7.
8. 1. Screening or targeting of appropriate
patients.
2. Assessment and development of
recommendations.
3. Implementation of recommendations
(physician and patient adherence).
9.
10. 1. Healthy elderly persons – living in the
community
2. Frail elderly persons – living in the
community
3. Institutionalized or severely impaired elderly
persons
11. Frail because of age
Decrease in functional status
Change in mental status- cognition/affect
Multiple medical problems
Multiple psychosocial problems
Take multiple medications
New onset urinary or fecal incontinence
Involuntary weight loss
Frequent falls
One or more sensory impairments
Disruptive behavior or personality changes
12.
13. Common problems that have been identified
as warranting special attention in elderly
3. Cognitive Disorders:(Dementia/Delirium)
4. Polypharmacy
5. Falls/Gait Instability
6. Urinary Incontinence
7. Depression
8. Malnutrition
14.
15. Medical assessment
Cognitive Function
Affective Disorders
Visual Impairment
Hearing Impairment
Dental Health
Functional Status
Nutritional Status
Gait and Balance Impairment
Social Support
Environment
Advance directives
18. Interview both( pt , care giver)
Use old medical records
More time consuming dt:
Communication problem (hearing, vision,slow
processing and cognitive impairment)
Underreporting
Vague nonspecific symptoms
Atypical presentation
Multiple comorbidity,etiologies
19. Previous surgical procedures
Major illnesses and hospitalizations
Previous transfusions
Immunization status
Preventive health measures
Mammography
Papanicolaou (Pap) smear
Tuberculosis history and testing
Medications
Previous allergies , adverse reactions
History of herbals, vitamins, laxatives
sleeping pills and cold preparations
Topical, OTC drugs
20. SEXUAL HISTORY: Active or not
FAMILY HISTORY
Irrelevant for dementia
Psychiatric illness are relevant like depression and
dysthymia
PAIN HISTORY
Characteristics of the pain
Relation of pain to impairments in physical and social
function
Analgesic history
Patient's attitudes and beliefs about pain and its
management
Effectiveness of treatments
21. Psychological history:
Sleep pattern
Behavioral history
Cognitive function
Affective disorder
Psychiatric disorder
23. Multiple complaints
Select the bothering one
The recently changing one
The new one
The backache for last 10 y with same ccc isn’t
worrisome but increasing severity is
24. Weight changes
Weight gain should prompt search for edema or
ascites
Gradual loss of small amounts of weight is
common
losses in excess of 5% of usual body weight over
12 months or less should prompt search of
underlying disease
Poor personal grooming and hygiene
Can be signs of poor overall function, caregiver
neglect, and/or depression; often indicates a
need for intervention
25. COMMON PHYSICAL FINDINGS AND THEIR
POTENTIAL SIGNIFICANCE IN GERIATRICS
VITAL SIGNS
Blood Pressure
Psuedo hypertension:( no end organ damage, osler’s
maneuver
Assess Orthostatic Hypotension 3 min 20/10
Irregular pulse
Arrhythmias are relatively common in otherwise
asymptomatic elderly
Temperature
Hypothermia is more common
Absent fever not exclude infection
26. Tachypnea
Baseline rate should be accurately recorded to
help assess future complaints (such as
dyspnea) or conditions (such as pneumonia or
heart failure)
Pain
is the 5th vital sign
27. Ulcerations
Lower extremity vascular and neuropathic ulcers
common
Pressure ulcers common and easily overlooked in
immobile patients
Diminished turgor
Often results from atrophy of subcutaneous tissues
rather than volume depletion
when dehydration suspected, skin turgor over chest
and abdomen most reliable
Bruising :suspect abuse
28. Nail:
Longitudinal ridges
Thin nail plate
Lost lanula
Ingrowing toe nail
Face:
Temporal a palpation ,tenderness
xanthoma
Eye
Enophtalmus:dt loss orbital fat
Entropion
Ectropion
Arcus senilis
Mouth
Missing teeth
Dentures often present; they should be removed to check for evidence of poor fit and
other pathology in oral cavity
Xerostomia, fissured tongue, leukoplakia, bleeding gum
edentulous
29.
30. Gum health
Area under the tongue is a common site for early
malignancies
SKIN
Multiple lesions
Actinic keratoses and basal cell carcinomas common;
most other lesions benign
Ecchymosis may be a sign of abuse
CHEST
Abnormal lung sounds
Crackles can be heard in the absence of pulmonary
disease and heart failure; often indicate atelectasis
31. CARDIOVASCULAR
Systolic murmurs
S4 normally may be heard in elderly
Ejection systolic murmur is Common and most often benign;
clinical history and bedside maneuvers can help to
differentiate those needing further evaluation.
Vascular bruits
Carotid bruits may need further evaluation as it confers more
coronary and cerebrovascular events
Femoral bruits often present in patients with symptomatic
peripheral vascular disease
Diminished distal pulses
Presence or absence should be recorded as this information
may be diagnostically useful at a later time (e.g., if symptoms
of claudication or an embolism develop)
32. BREAST EXAMINATION
Retraction of Nipple and areola
Exclude cancer
Masses or fixed breast
Test for Consistency and mobility to Exclude cancer
ABDOMEN and RECTAL EXAMINATION
Prominent aortic pulsation
Suspected abdominal aneurysms should be evaluated
by ultrasound
Fecal impaction
Common
Should be treated
33. GENITOURINARY
Atrophy
Testicular atrophy normal
Atrophic vaginal tissue may cause symptoms (such as
dyspareunia and dysuria) and treatment may be beneficial
Pelvic prolapse (cystocele, rectocele)
Common and may be unrelated to symptoms; gynecologic
evaluation helpful if patient has bothersome, potentially
related symptoms
Adnexal mass
Malignancy should be excluded
Urinary incontinence OR A chronically overfilled and
distended bladder
Search for prostate
34. EXTREMITIES
Periarticular pain
Can result from a variety of causes and is not always the result
of degenerative joint disease; each area of pain should be
carefully evaluated and treated
Limited range of motion
Often caused by pain resulting from active inflammation,
scarring from old injury, or neurologic disease; if limitations
impair function, a rehabilitation therapist could be consulted
Edema
Can result from venous insufficiency and/or heart failure; mild
edema often a cosmetic problem; treatment necessary if
impairing ambulation, contributing to nocturia, predisposing
to skin breakdown, or causing discomfort
Unilateral edema should prompt search for a proximal
obstructive process
35. NEUROLOGIC
Abnormal mental status (i.e., confusion,
depressed affect)
Delirium, dementia or depression should be
assessed.
Weakness
Arm drift may be the only sign of residual
weakness from a stroke
Proximal muscle weakness (e.g., inability to get
out of chair) should be further evaluated;
physical therapy may be appropriate
36.
37. Major eye diseases such as cataract,
macular degeneration, glaucoma, and
diabetic retinopathy increases with age.
Require eye glasses due to presbyopia.
Often unaware of their visual deficits.
38. Should ask questions regarding reading,
watching television, or driving. (H)
Snellen Chart is used to screen for visual
deficits. (T)
Patient stands 20 ft. from the chart and read
letters using corrective lens.
Inability to read >20/40 implies impairment in
vision.
Referral to Ophthalmologist if needed. (R)
39.
40.
41. Associated with decreased cognition,
depression, dissatisfaction with life, and
withdrawal from social activities.
Usually bilateral.
Occurs in the high frequency range.
43. Inability to hear 40 decibles tone at 1000 or
2000 Hz in one or both ears implies failed
hearing test.
44. An alternative to hand-held audio scope.
Done by whispering 3 – 6 words at a distance
of 8, 12, or 24 inches from the patient’s ear.
Examiner should stand behind the patient
and have one ear covered during the
examination.
Inability to repeat >50% of the whispered
words is considered a failed screening.
45. Whisper Test
3 words
12 to 24 inches
Macphee GJA Age Aging, 1988
46. 3. D o e s a h e a r in g p r o b le m c a u s e y o u t o f e e l
e m b a r r a s s e d w h e n y o u m e e t n e w p e o p le ?
Ye s S o m e t im e s N o
4. D o e s a h e a r in g p r o b le m c a u s e y o u t o f e e l
f r u s t r a t e d w h e n t a lk in g t o m e m b e r s o f
y o u r f a m ily ? Ye s S o m e t im e s N o
5. Do yo u ha ve d if f ic u lt y w h e n s ome one
s p e a k s in a w h is p e r ? Ye s S o m e t im e s
No
6. D o y o u f e e l h a n d ic a p p e d b y a h e a r in g
p r o b le m ? Ye s S o m e t im e s N o
7. Does a h e a r in g p r o b le m c aus e yo u
d if f ic u lt y w h e n v is it in g f r ie n d s , r e la t iv e s , o r
n e ig h b o r s ? Ye s S o m e t im e s N o
8. Does a h e a r in g p r o b le m c a u s e y o u t o
a t t e n d r e lig io u s s e r v ic e s le s s o f t e n t h a n
y o u w o u ld lik e ? Ye s S o m e t im e s N o
47. INSTRUCTIONS: The purpose of this scale is to identify the
problems your hearing loss may be causing you. Please select
YES, SOMETIMES, or NO for each question. Do not skip a
question if you avoid a situation because of your hearing
problem. If you use a hearing aid, please answer the way you hear
without a hearing aid.
Total ‘No’ _____ X 0 = _______
Total ‘Yes’ _____ X 4 = _______
Total ‘Sometimes’ _____ X 2 = _______
TOTAL SCORE _______
If your score is greater than 10, a hearing test is
recommended
50. مقياس الحالة العقليةالتوجه ) الهتداء(
تقدر تقول لي إحنا في سنة كام ؟
تقدر تقول لي إحنا في فصل إيه؟
تقدر تقول لي إحنا في شهر إيه؟
/5 تقدر تقول لي النهاردة إيه؟
تاريخ النهاردة ايه ؟
إحنا فين دلوقت؟
إحنا في الدور الكام؟ `
أنت تتبع حي إيه؟ ‚
أنت تتبع محافظة إيه؟ °
/5 ‚ إحنا في جمهورية إيه؟
51. تسجيل المعلومات
ا قولك 3 كلمات, قولهم ورايه, ها سالك عليهم تاني كمان شويه )كورة- شجرة- قلم(
/3
) أكثر من 5 سنوات دراسة( اطرح 7 من 001 و الباقي شيل منه 7 و أنت نازل, و توقف بعد 5
مرات:) 39-68-97-27-56(
ذا كان غير قادر علي الطرح: يتهجا كلمة أسيوط
) اقل من 5 سنوات دراسة ( اطرح 3 من 02 و الباقي شيل منه 3 وأنت نازل و توقف بعد 5 مرات
/5
استرجاع الذاكرة:
/3 قول ال 3 كلمات اللي قولناهم قبل كده )كورة –شجرة- قلم(
اللغة:
52. اكتب جملة مفيدة أو قول جملة مفيدة •
/1
ارسم هذا الشكل
____________Date _____ Total Score
53. Subjects told to 1 point for the clock circle
▪ Draw a large circle 1 point for all the numbers being in
▪ Fill in the numbers on a clock the correct order
face 1 point for the numbers being in the
▪ Set the hands at 8:20 proper special order
1 point for the two hands of the
No time limit given clock
Scoring (subjective): 1 point for the correct time.
▪ 0 (normal)
▪ 1 (mildly abnormal)
▪ 2 (moderately abnormal)
▪ 3 (severely abnormal)
A normal score is four or five points.
54.
55. Components
3 item recall: give 3 items, ask to repeat, divert and recall
Clock Drawing Test (CDT)
▪ Normal (0): all numbers present in correct sequence and
position and hands readably displayed the represented time
Give 1 point for each recalled word after the CDT
distractor. Score 1–3.
A score of O indicates positive screen for dementia.
A score of 1 or 2 with an abnormal CDT indicates positive screen for
dementia.
A score of 1 or 2 with a normal CDT indicates negative screen for
dementia.
A score of 3 indicates negative screen for dementia
56. Category fluency
Highly sensitive to Alzheimer’s disease
Scoring equals number named in 1 minute
Average performance = 18 per minute
< 12 / minute = abnormal
Requires patient to use temporal lobe semantic stores
60 seconds
Using a cutoff of 15 in one minute:
Sens 87% - 88%
Spec 96%
57.
58. Highest prevalence of depression and suicide in elderly
Geriatric Depression Screen (GDS)- Yesavage
30 y/n questions
15 y/n questions
Single question just as sensitive
▪ Do you feel sad or depressed?
▪ Are you worried something bad will happen to you?
59. : ﺈختر الجواب اﻷنسب لحالتك النفسية خلل اﻷسبوع الماضي
1- هل ﺃنت بشك ٍ عام را ٍ عن حياتك ؟ نعم كل
ض ل
2- هل تخّيت عن العديد من نشاطاتك و ﺇهتماماتك ؟ نعم كل ل
3- هل تشعرۥ ﺃ ّ حياتك فارغة ؟ نعم كل
ن
4- هل تصاب بالملل عادة" ؟ نعم كل
5- هل ﺃنت في مزا ٍ حسن في ﺃغلبية الوقت ؟ نعم كل
ج
6- هل تخاف ﺃن يصيبك مكروه ؟ نعم كل
7- هل تشعرۥ بالسعادة ﺃغلبية الوقت ؟ نعم كل
8- هل تشعرۥ عادة" ﺃّك بحاجة ﺇلى مساعدة ؟ نعم كل
ن
9- هل تف ّل البقاء في غرفتك على الخروج و القيام بنشاطا ٍ جديدة ؟ نعم كل
ت ض
01- هل تشعرۥ ﺃ ّ مشاكل الذاكرة تصيبك ﺃكثر من غيرك ؟ نعم كل
ن
11- هل تعتقد ﺃّه ﻷم ٌ رائع بقاؤك حيا" الن ؟ نعم كل
ر ن
21- هل تشعرۥ ﺃّك ل تجدي نفعا" في الوقت الحالي ؟ نعم كل
ن
31- هل تشعرۥ ﺃّك شديد النشاط ؟ نعم كل
ن
41- هل تعتقد ﺃ ّ وضعك ميؤوس منه ؟ نعم كل
ن
51- هل تعتقد ﺃ ّ ﺃغلبية الّاس بوض ٍ ﺃفضل من اّذي ﺃنت عليه ؟ نعم كل
ل ع ن ن
60. Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
61. 10. Do you feel you have more problems with memory than most? YES /
NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO
Answers in bold indicate depression. Although differing sensitivities and
specificities have been obtained across studies, for clinical purposes a
score > 5 points is suggestive of depression and should warrent a follow-
up interview. Scores > 10 are almost always depression.
62.
63. Basic Activities of Daily Living (ADLs)
Tasks essential to be independent in your own
home or room
Instrumental Activities of Daily Living (IADLs)
Tasks essential to be independent in the
community
Advanced Activity of Daily Living (AADLs)
64. Bathing (sponge, shower, or tub)
Independent: needs no assistance
Assisted: needs assistance only in bathing a single part (as back or
disabled extremity)
Dependent: needs assistance in bathing more than one part of the body
and in getting in or out of tub or does not bathe self
Dressing
Independent: gets clothes from closets and drawers; puts on clothes,
outer garments, braces; manages fasteners; act of tying shoes excluded
Assisted: need partial assistant
Dependent: does not dress self or remains partly undressed
Toileting
Independent: gets to toilet; gets on and off toilet; arranges clothes; cleans
organs of excretion (may manage own bedpan used at night only and may
not be using mechanical supports)
Assisted: receives assistance in getting to and using toilet
Dependent: uses bedpan or commode
65. Transfer
Independent: moves in and out of bed independently and moves in and out of
chair independently
Assisted: using mechanical supports
Dependent: assistance in moving in or out of bed and/or chair; does not perform
one or more transfers
Continence
Independent: urination and defecation entirely self-controlled
Assisted: : partial or incontinence in urination or defecation; or partial control by
enemas, catheters, or regulated use of urinals and/or bedpans
Dependent total incontinence in urination or defecation; partial or total control by
enemas, catheters, or regulated use of urinals and/or bedpans
Feeding:
Independent: gets food from plate or its equivalent into mouth (precutting of
meat and preparation of food, as buttering bread, are excluded from evaluation)
Assisted: assistance in act of feeding
Dependent: does not eat all or parenteral feeding
66. The Index of Independence in Activities of Daily Living is based on an
evaluation of the functional independence or dependence of patients in
bathing, dressing, toileting,transferring, continence, and feeding.
Specific definitions of functional independence and dependence appear
below the index.
A – Independent in feeding, continence, transferring, toileting, dressing,
and bathing
B – Independent in all but one of these functions
C – Independent in all but bathing and one additional function
D – Independent in all but bathing, dressing, and one additional function
E – Independent in all but bathing, dressing, toileting, and one additional
function
F – Independent in all but bathing, dressing, toileting, transferring, and
one additional function
G – Dependent in all six functions
Other – Dependent in at least two functions, but not classifiable as C, D,
E, or F.
67. bility to Use Telephone
Operates telephone on own initiation, looks up and dials numbers, etc. 1
Dials a few well-known numbers 1
Answers telephone but does not dial 1
Does not use telephone at all 0
hopping
Takes care of all shopping needs independently 1
Shops independently for small purchases 0
Needs to be accompanied on any shopping trip 0
68. ousekeeping
Maintains house alone or with occasional assistance (e.g., on heavy work-domestic help) 1
Performs light daily tasks such as dishwashing, bed making 1
Performs light daily tasks but cannot maintain acceptable level of cleanliness 1
Needs help with all home maintenance tasks 1
Does not participate in any housekeeping tasks 0
aundry
Does personal laundry completely 1
Launders small items ”rinses socks, stockings, etc. 1
69. esponsibility for Own Medications
Is responsible for taking medication in correct dosages at correct times 1
Takes responsibility if medication is prepared in advance in separate dosages 0
Is not capable of dispensing own medication 0
bility to Handle Finances
Manages financial matters independently (budgets, write checks, pays rent, bills, goes to
bank), collects and keeps track of income 1
70. Evaluates the persons ability to participate in
societal, community, and family roles.
It also assesses for recreational and
occupational activities. These activities
varies among individuals and may be a
valuable tools in monitoring functional status
prior to the development of disability.
71. Patient specific activities that can be used to
detect subtle functional losses in high
functioning patients
Can be job or recreation oriented
Socializing, playing bridge , working, playing
golf, playing music, dancing, practicing law,
flying a plane, gardening.
72.
73. Food taken (type, quantity, frequency)
No of hot meal / week
Characteristic diet (low salt , low protein)
Alcohol intake
Fluid intake
Dietary fiber
OTC vitamin , herbal medicine
pt’s ability to feed himself
Change in taste ,smell, teeth
74. MNA® Short Form
Nutrition Screening Initiative
DETERMINE checklist
MUST (Malnutrition Universal
Screening Tool)
Nutrition Risk Screening (NRS)
(ESPEN)
75. 1. Body mass index (BMI)
(kg/m2)
2. Weight loss in past 3 months?
3. Acute illness or major stress in
past 3 months?
4. Mobility
5. Dementia or depression
6. Has appetite & food intake
declined in past 3 months?
76. MNA > 23: dietary
informations
MNA < 17: refer to a
specialist, do more
comprehensive
assessment, using
biological markers:
albumin, CRP..
MNA between 17 and 23:
Were the patient have
difficulties, how can we
help, useful for
intervention studies
77.
78. YES
1. Do you have an illness or condition that made you change the kind and amount of 2
food you eat.
2. Do you eat fewer than two meals per day. 3
3. Do you eat few fruits, vegetables, or milk products. 2
4. Do you have 3 or more drinks of beer, liquor or wine almost every day. 2
5. Do you have tooth or mouth problems that make it hard for you to eat. 2
6. Do you always have enough money to buy food. 4
7. Do you eat alone most of the time. 1
8. Do you take 3 or more different prescribed or over the counter drugs per day. 1
9. Without wanting to, have you lost or gained 10lbs. in the last 6 months. 2
10. Are you physically unable to shop, cook, or feed yourself. 2
A score of 0-2 is good, 3-5 moderate nutritional risk and greater than 6
equal high nutritional risk.
79.
80.
81.
82. Diet
A more precise questionnaire is needed to have the correct amount of
consumed intake.
▪ The 7-day dietary record routine seems to have a good
reproducibility in assessing the intake of energy and fluids in
geriatric patients, but may be to long and to complex for non
expert professionals.
▪ 3-day food records could be sufficient for a correct estimation of
current food intake.
Some new validated method is proposed as the photography method
of nutritional assessment
83. Physical Exam
▪ Loss of SQ fat
▪ Muscle wasting
▪ Edema in ankles
▪ Edema in sacral area
▪ Ascites
▪ Anthropometric parameters
Weight, body mass index are the most important anthropometrics parameters,
84. Weight
Individuals removed shoes and heavy cloths prior to weighing.
Height
Subjects stood with their scapula, buttocks and heels resting against a wall, the neck was held in a
natural non-stretched position, the heels were touching each other, the toe tips formed a 45°
angle and the head was held straight with the inferior orbital border in the same horizontal
plane as the external auditive conduct (Frankfort's plane).
Body circumferences
Mid-brachial, calf, waist and hip circumferences were measured using a flexible non-elastic
measuring tape. Individuals stood with feet together and arms resting by their sides. The hip
circumference was measured from the maximum perimeter of the buttocks. The waist
circumference was taken as the plane between the umbilical scar and the inferior rib border.
The waist circumference was used to identify individuals with possible health risks based upon
threshold values of ≥ 88 cm for women and ≥ 102 cm for men
Knee-heel length
Body-mass index (BMI)
BMI was estimated by dividing weight (kg) by height2 (m2) . Individuals were considered
malnourished if their BMI was less than 18.5, normal from 18.5 to 24.9 and overweight if ≥ 25
Waist to hip ratio (WHR)
This was estimated by dividing waist circumference by hip circumference . The threshold WHR was
≥ 0.85 for women and ≥ 1.00 for men
85. Biochemical parameters
Plasma albumin, Cholesterol, Hemoglobin and Transferrin are the
most used laboratory parameters in long term care.
CRP, total lymphocytes may also be used linked to higher mortality)
86. At entry: Weight, BMI, MNA,
Every 3 months: Weight, if weight loss more than 2
kg,
▪ MNA
▪ Weight each months
87.
88. >6 concurrent diagnosis.
>12 doses of medications per day.
A prior ADE.
A low body weight or BMI.
Age >85 years.
Creatinine clearance <50ml/minute.
89.
90. Previous history of falls causes and
treatments.
Did you fall last year ?
Location & circumstances of Fall
Associated symptoms
Other falls or near falls
Medications (including nonprescription) and
alcohol
Injury & ability to get up
91. Lower extremity or quadriceps
weakness can evaluated by asking
the patient to stand from a seated
position in a hard back chair while
keeping their hands folded.
Inability to complete this task
suggest lower extremity weakness
and is highly predictive for future
disability.
92. Gait Observations
Initiation of gait Step length Step height
Step continuity Step symmetry Walking stance
Amount of trunk sway Path deviation
Gait speed
▪ 0.8 meters/sec indicates that the patient is capable of independent
ambulation within the community.
▪ of 0.6 meters/sec indicates participation in community activities
without the use of a wheelchair
▪ Patients who can ambulate 50 feet in the office corridor in 20
seconds or less should be able to walk independently in normal
activities
93. Sitting balance (leaning vs steady)
Ability to rise from chair
Immediate standing balance
Standing balance (wide based, narrow based or
assisted)
Sternal nudge
Standing balance w/ eyes closed
94. BALANCE SCORE = _____/16
Gait score=- _____/12
TOTAL SCORE (Gait + Balance ) = _____/28
{< 19 high fall risk, 19-24 medium fall risk,
25-28 low fall risk}
95.
96.
97. ONLY VALID FOR PATIENTS NOT USING AN
ASSISTIVE DEVICE
The task of rising from an armless chair, walking
10ft, turn, walk back and sit down is termed the
“Get-up and Go Test.” Those taking long than 10
seconds to complete this tasks are at increased risk
for falls
Seconds Rating
<10 freely mobile
<20 mostly independent
20-29 variable mobility
>30 assisted mobility
Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “Get-up and Go” test. Arch
phys Med Rehabil. 1986; 67(6): 387-389.
99. Location
Quality
Severity
Duration
Exacerbating/relieving factors
Efficacy of current treatmen
Impact on mobility
Impact on sleep
Impact on appetite
Imact on mood
Impact on social life
105. Duration, severity, symptoms, previous
treatment, medications, GU surgery
3 P’s
Position of leakage (supine, sitting, standing)
Protection (pads per day, wetness of pads)
Problem (quality of life)
Reversible causes (Diappers)
Categorize incontinence
Bladder record or diary
109. Should include availability of help in case of
emergency.
Availability of a personal support system.
Living arrangement.
Relationship with (family, friends, neighbours)
Social activities, hobbies, spiritual participation
Need for a caregiver.
Caregiver burdens.
Economic status.
Elder mistreatment.
Advanced directives.
110. For the frail elderly availability of help from
family or friends can determine whether a
functionally dependent person remains at
home or is institutionalized.
For those frail elders that lack support, a
visiting nurse may be helpful in the
assessment of home safety and level of
personal risk, i.e., stairs, location of
bathrooms, bathroom grab bars, and smoke
alarms.
111. S - Do you feel Safe at home? What Stress do
you feel in your relationship?
A - Do you feel Afraid or have you been
Abused by any of your caregivers?
F - Are there any Family or Friends that you
could ask for help or support?
E – Do you have a safe place to go in case of
an Emergency? Is it an Emergency now?
112. Caregiver does not come to appointments
Is concerned about medical costs
History of substance abuse, mental health
problems, conflicts with patient
Dominates interview, won’t leave, won’t let
patient talk
Defensive, hostile, or indifferent
Dependence on patient for income/housing
113.
114. D - Dementia, Depression, Drugs
E - Eyes
E - Ears
P - Physical Performance, Phalls, Psychosocial
I - Incontinence
N -Nutrition
115. Start low , go slow
Try to limit number of medications and avoid prescribing “a
pill for every ill”
Try not to start two drugs at the same time
Make sure it is the right dose
Avoid “inappropriate medications”- Beers criteria
Watch out for potential drug-drug, drug-disease interactions
Make sure patient and caregiver understand what the
medication is for , how and when to take it, possible side
effects
116. At least annually:
Ask patient to bring in all medications (including
OTC, herbal prep)
Ask patient how each medication is being taken
Look for medications with duplicate therapeutic
or pharmacologic profiles
Eliminate unnecessary medications
Simply the medication regimen – fewest
possible number of medications and doses per
day
Always review any changes in writing with the
patient and caregiver, provide the changes in
writing