Geriatric assessment ROLE OF PHYSIOTHERAPIST

1. Geriatrics: Scheme of
Evaluation & Role of
Physiotherapist
DR.RAMANDEEP SAINI, PT
ASSISTANT PROFESSOR-COMMUNITY PHYSIOTHERAPY

2. OBJECTIVES
• By the end of today’s session, students will be able to:
• Know and understand the importance of geriatric assessment
• Role of physiotherapist in geriatrics
• Understand various domains of geriatric assessment
• Use each outcome measure effectively

3. Importance of geriatric assessment
• Goal: promote wellness and independence
• Focus: function and performance
• Approach: multidisciplinary
• Efficiency: ability to perform rapid screening to identify target areas
• Success : maintaining or improving QOL

4. Role of PT
• To address functional limitations
• To encourage and maintain a healthy lifestyle
• To provide safe environment
• Referral to other specialists
• To educate the elderly population about the various services and support that are
available for them
• Conducting assessments at home: The assessor can observe the living and
family situation & Address potential barriers

5. Communication strategies
• Introduce yourself
• Face the person directly
• Sit at eye level
• Speak slowly
• Ask open ended questions
• If hearing deficits, raise voice volume accordingly
• Allow ample time for the person to answer

6. Major components of Assessment
Functional capacity
Fall risk
Urinary incontinence
Poly-pharmacy
Cognition
Nutrition
Social support
Vision/hearing
Financial concerns

7. PATIENT INFORMATION
• Name
• Age
• Gender
• Address: community dwelling/ old age homes
• Occupation
• Co-morbid factors
• Chief complaints
• HOPC

8. Drug history
Family history
Personnel history
sleep, appetite/nutrition history, bowel/bladder function
Previous surgical history
Previous medical history
DM, HTN, BA, Koch’s
Pain history
Chief complaints
Demographic details
Name, age, gender, residence, dominance, Occupation

9. Social history
Environment history
Psychological history
Socio economic status (Modified Kuppuswamy scale)
Investigations performed
Systemic review
Musculoskeletal, Neurological symptoms, Cardio respiratory, Special senses, Genitourinary

11. MEDICAL/PHYSICAL ASSESSMENT

12. Observation
BUILT
Posture
Gait
Attitude of limb
Use of assistive devices
swelling
Palpation
Vitals: BP, PR, RR, SPO2 , temperature, ulcers
Tenderness
Spasm
PICCKLE
P - Pallor · I - Icterus · C - Cyanosis · C -
K(C)lubbing · L - Lymphadenopathy · E - Edema.
Chest expansion and excursion

13. Musculoskeletal assessment
• ROM- goniometer
• MMT- manually, dynamometer
• Tightness
• Muscle wasting
• Joint play
• Limb length discrepancy

14. Neurological
assessment
CNS
Orientation, Memory,
Intellectual Function,
Thought Process
Cranial nerve
examination
PNS
Motor examination-
Muscle tone, strength,
Voluntary control
Reflexes- superficial,
deep and cortical
reflexes
Sensory examination :
Superficial sensations: deep
pain, light touch, temperature
Deep sensations: proprioception,
vibration
ANS
Bowel bladder
N
E
U
R
O
L
O
G
I
C
A
L
A
S
S
E
S
S
M
E
N
T

15. COGNITIVE DOMAIN

16. Score >26 is considered normal

18. • I Olfactory Nerve: smell.
• II Optic Nerve: Vision.
• III, IV, VI Oculomotor, Trochlear & Abducent nerve: extraocular movements.
• V Trigeminal Nerve: face sensations, motor muscles of mastication.
• VII Facial Nerve: Motor to muscles of facial expression, taste to anterior 2/3 of
tongue, sensation to ear canal and palate.
• VIII Vestibulocochlear Nerve:
i. Cochlear part: conductive/ deafness.
ii. Vestibular part

19. • IX Glossopharyngeal Nerve: Sensation to pharynx, middle & inner ear, post 1/3 tongue, taste post 1/3
tongue
• X Vagus Nerve: Sensation to pharynx and larynx. XI Spinal accessory nerve: Motor to
sternocleidomastoid and trapezius muscles.
• XII Hypoglossal Nerve: Motor to muscles of tongue

20. URINARY INCONTIENCE
• UDI 6
• IIQ 7
• Bladder record or
diary

21. SOMATOSENSORY,VISION AND
SENSORY ASSESSMENT
A. Sensory:
1. Vision:
• Visual acuity: estimated by reading the snellen chart with both eyes and then
each eye separately .
• The most common visual problem among older adults is presbyopia, or difficult
focusing on near objects.
• Contrast sensitivity test:
• Ability to detect differences in shading and patterns.
• It is important in detecting objects with clear outlines and discriminating
objects or details from their background, such as the ability to discriminate
steps covered with a patterned carpet.

22. • Measured by using contrast sensitivity chart such as Hamilton-veale Contrast Test Chart.
Person is asked to read all the letters they can see on the special visual chart
• Depth perception: is the ability to distinguish distances between objects.
• Hold your index finger point upward in front of the patient at the eye level, one finger closer
to the patient than the other. Gradually move the index finger toward each other (1 forward 1
back), until the patient identifies when the fingers are parallel or lined up.
• If the patients perception of parallel is off by 3 in or more then depth perception may be a
problem.

23. • Visual field restriction: peripheral vision is the ability to see from the side while
looking straight ahead.
• To test peripheral vision, the examiner brings his fingers from behind the patients
head at eye level while the patient look straight ahead.
• The patient identifies when he or she 1st notices the examiners finger in his or her
side view.
• A significant field cut unilateral or bilateral would be important to notice.
• Loss of central vision, seen with macular degeneration, also related to falling.

24. 2. Vestibular:
• VOR can be tested clinically by asking the patient to focus on
a fixed target and move the head to the right and left
(horizontally) and then up and down (vertically) with various
speeds.
• Head thrusts- Ask the patient to relax and allow you to move
his or her head and check his or her cervical ROM. Then ask
the patient to focus on a fixed target directly in front of him or
her (usually your nose) while you move the patient’s head
rapidly over a small amplitude. Observe the patient’s ability to
sustain visual fixation on the target and look for corrective
saccades plus note the head thrust direction if a saccade
occurs. A positive head thrust test indicates an impaired VOR
due to a peripheral lesion.

25. Somatosensory:
3. Somatosensory: includes
• Proprioception (joint position sense of movement)
• Vibration (placing tuning fork at the 1st MT head)
• Cutaneous pressure sensation and 2 point discrimination

26. HEARING
• Whisper VoiceTest
• Requires quiet environment
• Procedure: cover one ear. Therapist should stand posterior or posterolateral to
the patient and whisper 3-6 random words at a set distance 12-24 inches.
• Patient should be able to respond at least 50% of the words

27. If score >10 hearing test is
recommended

28. FUNCTIONAL BALANCE AND GAIT:
• Romberg’s test
• A “positive” Romberg occurs if the person demonstrates substantially more sway
or loses balance when comparing standing in Romberg position with eyes open
for 20 to 30 seconds to standing in Romberg with eyes closed.
• A positive Romberg test should make one suspect sensory loss distally and lead
to testing distal lower limb sensation.

29. • FISCIT-4 Tests of Static Balance:
parallel, semi-tandem, tandem, and one-legged stance
tests (Total score of 28)
• Mini BESTest- Components: Anticipatory (6), reactive
postural control (6), sensory orientation (6), dynamic
Gait (10)
• Timed Up and Go (TUG)
• POMA (25-28 = low fall risk 19-24 = medium fall risk <
19 = high fall risk)
• 30 sec chair stand test

31. PHYSICAL FITNESS
TESTING

32. PHYSICAL FITNESS TESTING: THE
SENIOR FITNESS TEST

36. • BADL’S (Barthel’s, Katz)
• IADL’S (Lawton and Brody)
• AADL’s (These advanced activities include the ability to
fulfill societal, community, and family roles as well as
participate in recreational or occupational tasks.)
FUNCTIONAL ASSESSMENT

39. PSYCHOLOGICAL DOMAIN
• Geriatric depression scale (GDS)
• WHOQOL-BREF

41. ENVIRONMENTAL ASSESSMENT
• Type of House
• Building or row house
• Flooring of house
• Lightening:- dark or light of which room.
• Colour of Room:- Bright or sober/light
• Staircase (how many steps and approx. ht of each steps) or lift
• Railing:- present/absent
• Toilet:- inside/outside the house, flooring, lightening, Indian or western and height of western toilet.
• Spacing near by bed and rooms
• Height of bed & chair and type of cushion used in it.
• Width of doors of room and entrance
• How many Handles attached totally in house and where(toilet)
• Foot wear?
• Obstacles near room and or outdoor.

43. HOME SAFETY SELF ASSESSMENT TOOL
(HSSAT)-

44. SOCIAL LIFE ASSESMENT
Attends or not
1. Family function
2. Social gathering (old age ppl group)
3. Anxiety, depression, family disputes
4. Fear
5. Family support or not
6. Spouse

45. NUTRITIONAL STATUS

46. REFERENCES
• Guccione A. Geriatric Physical Therapy. 3rdedition
• ACSM,10 edition
• FIT INDIA,2019

47. THANK YOU