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THE 10 MINUTE  GERIATRIC ASSESSMENT ,[object Object],[object Object],[object Object],[object Object],[object Object]
OFFICE-BASED  ASSESSMENT ,[object Object],[object Object],[object Object],[object Object]
Falls “ Phalls” Confusion Incontinence Iatrogenic disorders Impaired homeostasis GERIATRIC GIANTS
“ DEEP IN” FOR QUICK SCREENING ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SILENT DEMENTIA ,[object Object],[object Object],[object Object]
DEMENTIA SCREEN 1   THREE ITEM RECALL ,[object Object],[object Object],[object Object],[object Object]
DEMENTIA SCREEN  2 VERBAL FLUENCY-CATEGORY RETRIEVAL or “ANIMAL NAMING” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANIMAL NAMING Useful screening tool for dementia  Average performance=18/min Less than 12/min is abnormal Correlates well with MMSE scores(r=0.77) Worsens  with  time  in  AD Neurology.1989;39:1159-1165 .
DEMENTIA SCREEN  3 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Watson YL et al., Clock Completion: An Objective screening test for dementia.  JAGS 1993; 41:1235-40
CLOCK COMPLETION TEST (CCT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INSTRUMENTAL ACTIVITIES OF DAILY LIVING  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DEMENTIA SCREEN  4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DEMENTIA SCREEN  5   Seven Minute Neurocognitive  Screening for Alzheimer’s Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],7 MINUTE NEUROCOGNITIVE SCREEN
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
D EPRESSION ,[object Object],[object Object],[object Object]
5 ITEM GDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],    
D RUGS ,[object Object],[object Object],[object Object],[object Object],[object Object]
SIMPLE SCREENS OF HEARING LOSS Sen 80% Spec 80% at cut point of  > 3 < 2 min NHANES Battery Sen 48-63% Spec 75-86%  At cut point >8 2 min Hearing-Handicap Inventory for the elderly Sen 80-100% Spec 82-89% 1 min Whisper Test Sen 87-90% Spec 80-100% 1-2 min Audioscope Comments Time to Administer Question/Test
E ARS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
E ARS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
E YES ,[object Object],[object Object],[object Object],[object Object],[object Object]
E YES ,[object Object],[object Object],[object Object]
P hysical Performance Testing in the Elderly (PPT) ,[object Object],[object Object],[object Object],[object Object],[object Object]
P HYSICAL   PERFORMANCE TESTING (PPT) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
P HYSICAL PERFORMANCE TESTING DISADVANTAGES ,[object Object],[object Object],[object Object],[object Object]
WHAT IS THE RISK OF ADL DEPENDENCE IN THE AGED WITH COGNITIVE IMPAIRMENT? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RISK FACTORS FOR  FUNCTIONAL DEPENDENCE Older Age Female Living Alone Non-white Poor Less Education Smoking HBP Abnormal BMI Heart Disease Cognitive  Impairment
ADL DEPENDENCE IN MILD/MOD DEMENTIA Prospective, Longitudinal  Study of 1,103 Elderly (Age 72 & Older) with Mild/Mod  Dementia, Independent In ADL Assessed  I Yr Later  For Development Of ADL Impairment and Risk Factors What PPTS Predicted Maintenance of ADL?  J Gerontol Med Sci 1995;50A:M235-241.
PREDICTORS OF ADL DEPENDENCE SELF REPORTED RISK FACTORS ASSOCIATED WITH ONSET OF ADL   (p<.O5) 1)  Lived Alone (rr-3.8) 2)  Not Currently Married (rr-4.3) 3)  Impairments > 4 IADLs (rr-2.9) J Gerontol Med Sci 1995;50A:M235-241.
PREDICTORS OF ADL DEPENDENCE   ,[object Object],[object Object],[object Object],[object Object]
QUALITATIVE CHAIR STAND Abnormal Normal High Risk 12/31  (39%) 10 ft. Rapid Gait/3 Chair Rises High Risk 13/38  (34%) Low Risk 6/128  (4.7%) Abnormal Normal
SIMPLE TESTS OF LOWER EXTREMITY STRENGTH, BALANCE, GAIT & FALL RISK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 min Functional reach Comments Time to  Administer Question/Test
RELATIVE RISKS OF SEVERE WALKING DISABILITY: COMBINED DISTRIBUTION OF KNEE STRENGTH TERTILES AND BALANCE CATEGORES JAGS, 2001-Vol.49, No.1 1 1.14 0.97 SS (10)+ST (10) +TS (>3s) 1.18 1.58 1.87 SS (10)+ST (10) +TS (<3S) 3.08 1.49 5.12 S-S<10 seconds RR RR RR Balance Categories Strongest (<15.1kg) Average (10.6-15.1 kg) Weakest (<10.6 kg) Knee Strength Tertiles
Balance Categories The rates of onset of severe walking disability in groups based on baseline knee-extension strength tertiles and standing balance categories in women who did not have severe walking disability at baseline.  The follow-up time was 3 years with examinations taking place every 6 months. Knee Extension Strength Tertiles JAGS, 2001-Vol.49,No1
Geriatric Syndromes  P HALLS (Falls) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
I NCONTINENCE ,[object Object],[object Object],[object Object],[object Object]
PERSISTENT  UI ,[object Object],[object Object],[object Object],[object Object]
NUTRITION SCREENS Odds Ratio 2.7 if 3-5 RF, 6.4 if  >  6 RF 5-10 min NHANES 14-item scale to detect hypoalbuminemia Sen 36%, Spec 85% for intake of  >  3 nutrients below 75% of RDA at cut point  >  6 points  <5 min Nutrition Screening PPV malnutrition .99 1 min ,[object Object],RR of death 2.0 <1min ,[object Object],BMI <22 or >25 1 min ,[object Object],Comments Time to  Administer Question/Test
GERIATRIC  Weight Loss ,[object Object],[object Object],[object Object],[object Object],[object Object]
OLD PEOPLE AT HOME:   Empty Refrigerator Predicts Hospitalization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EMPTY REFRIGERATOR PREDICTS HOSPITALIZATION (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ DEEP IN” For QUICK Screening ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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The 10 Min Geriatric Assessment

  • 1.
  • 2.
  • 3. Falls “ Phalls” Confusion Incontinence Iatrogenic disorders Impaired homeostasis GERIATRIC GIANTS
  • 4.
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  • 7.
  • 8. ANIMAL NAMING Useful screening tool for dementia Average performance=18/min Less than 12/min is abnormal Correlates well with MMSE scores(r=0.77) Worsens with time in AD Neurology.1989;39:1159-1165 .
  • 9.
  • 10. Watson YL et al., Clock Completion: An Objective screening test for dementia. JAGS 1993; 41:1235-40
  • 11.
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  • 20. SIMPLE SCREENS OF HEARING LOSS Sen 80% Spec 80% at cut point of > 3 < 2 min NHANES Battery Sen 48-63% Spec 75-86% At cut point >8 2 min Hearing-Handicap Inventory for the elderly Sen 80-100% Spec 82-89% 1 min Whisper Test Sen 87-90% Spec 80-100% 1-2 min Audioscope Comments Time to Administer Question/Test
  • 21.
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  • 29. RISK FACTORS FOR FUNCTIONAL DEPENDENCE Older Age Female Living Alone Non-white Poor Less Education Smoking HBP Abnormal BMI Heart Disease Cognitive Impairment
  • 30. ADL DEPENDENCE IN MILD/MOD DEMENTIA Prospective, Longitudinal Study of 1,103 Elderly (Age 72 & Older) with Mild/Mod Dementia, Independent In ADL Assessed I Yr Later For Development Of ADL Impairment and Risk Factors What PPTS Predicted Maintenance of ADL? J Gerontol Med Sci 1995;50A:M235-241.
  • 31. PREDICTORS OF ADL DEPENDENCE SELF REPORTED RISK FACTORS ASSOCIATED WITH ONSET OF ADL (p<.O5) 1) Lived Alone (rr-3.8) 2) Not Currently Married (rr-4.3) 3) Impairments > 4 IADLs (rr-2.9) J Gerontol Med Sci 1995;50A:M235-241.
  • 32.
  • 33. QUALITATIVE CHAIR STAND Abnormal Normal High Risk 12/31 (39%) 10 ft. Rapid Gait/3 Chair Rises High Risk 13/38 (34%) Low Risk 6/128 (4.7%) Abnormal Normal
  • 34.
  • 35. RELATIVE RISKS OF SEVERE WALKING DISABILITY: COMBINED DISTRIBUTION OF KNEE STRENGTH TERTILES AND BALANCE CATEGORES JAGS, 2001-Vol.49, No.1 1 1.14 0.97 SS (10)+ST (10) +TS (>3s) 1.18 1.58 1.87 SS (10)+ST (10) +TS (<3S) 3.08 1.49 5.12 S-S<10 seconds RR RR RR Balance Categories Strongest (<15.1kg) Average (10.6-15.1 kg) Weakest (<10.6 kg) Knee Strength Tertiles
  • 36. Balance Categories The rates of onset of severe walking disability in groups based on baseline knee-extension strength tertiles and standing balance categories in women who did not have severe walking disability at baseline. The follow-up time was 3 years with examinations taking place every 6 months. Knee Extension Strength Tertiles JAGS, 2001-Vol.49,No1
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