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The geriatric assessment
The document discusses geriatric health maintenance and comprehensive geriatric assessments. It outlines the components of primary, secondary, and tertiary prevention for older adults, including screening tests, immunizations, and identifying/managing common conditions like falls, incontinence, and medication management. Comprehensive geriatric assessments evaluate multiple domains like function, cognition, mood, social support and goals of care to develop care plans for older patients.
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The geriatric assessment
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- 2. Geriatric Health Maintenance • Primarycare setting • Routine Health Maintenance • Identifies indicators of quality of life • Screening • Preventative Interventions • Whole Health Management Comprehensive Geriatric Assessment (CGA) • Allied Health assessment • Identifies common and frequently unrecognized impairments in older adults • CHF • Depression, Isolation, Dementia • Functional Instability, Falls • Predicted High Healthcare Utilization
- 3. • Patient centeredcomplete and through History and Physical • Preventative Measures • Primary Prevention • Secondary Prevention • Tertiary Prevention • Whole Health Management • Medications • Driving • Financial and Social Support • Abuse • Advance Care Directives
- 4. • Primary Prevention Toavert the development of disease • Encourage Physical Activity and counsel against Alcohol and Tobacco • Discuss prophylactic Aspirin in CV Risk patients • Immunizations • Influenza – Annually • Pneumococcal – >65y.o. (PPSV23) • Herpes Zoster – >60y.o. GERIATRIC HEATH MAINTENANCE
- 5. • Secondary Prevention Earlydetection and treatment of asymptomatic disease • Cancer Screenings • Prostate – Between 50-69y.o. • Colorectal – Between 50-75y.o. (85y.o. for High Risk patients) • Breast – Controversial Guidelines • Typically every 1-2 years for females with ≥4 years life expectancies. • Cervical – Between 21-65y.o. with adequate recent screening. • Three consecutive negative cytology test OR • Two consecutive negative Pap in the last 10 years • May start screening women under 21 who are sexually active GERIATRIC HEATH MAINTENANCE
- 6. • Secondary Prevention Earlydetection and treatment of asymptomatic disease • Blood Pressure Screening • Lipid Screening • Osteoporosis (DEXA) • Routine Bone Density (DEXA) • Women ≥65y.o. • High Risk Women ≥60y.o. • Abdominal Aortic Aneurysms • One-time Abdominal US • Men ≥65y.o. who have smoked or have AAA in PFHx GERIATRIC HEATH MAINTENANCE
- 7. • Tertiary Prevention Identificationof disease to prevent further morbidity or functional decline • Functional • Focused on activities of daily living • Cognitive • Targeted screening in patients with • Memory complaints • New functional impairment • Vision • Decreased visual acuity increases fall and mortality risk • General Ophthalmologic Exam every 1-2 years • Depression • "Over the past two weeks have you felt down, depressed, or hopeless?" • "Over the past two weeks have you felt little interest or pleasure in doing things?" GERIATRIC HEATH MAINTENANCE
- 8. • Tertiary Prevention Identificationof disease to prevent further morbidity or functional decline • Hearing • 3rd most common ailment (HTN, Arthritis) • Associated with depression, social isolation, functional decline • Whisper test almost as effective as formal studies • Nutrition • Routine Nutritional Assessments necessary • Vit B12, Vit D, Calcium typically low • Mobility/Falls • ~30% of noninstitutionalized older adults fall every year. • 5% of falls result in fracture/hospitalization • Regular assessments necessary • Circumstances of falls, orthostatic vitals, visual acuity, cognitive testing, gait, balance, iatrogenic causes • Incontinence • Major psychosocial impact • Routine targeted H/P with Urine/Blood testing indicated GERIATRIC HEATH MAINTENANCE
- 9. • Medications • Multiplemedication increase the risk of Drug-Drug interactions • Maintain up-to-date medications (including OTC/herbal) • Annual comprehensive reviews • Assess for duplications, drug-drug contraindications, affordability • Altered pharmacokinetics/dynamics increase risk of ADR • Assess specific classes associated with ADR • Warfarin, Analgesics (NSAIDs), Antihypertensives (ACE- I, Diuretics), Insulin, hypoglycemic agents (Nitro), psychotropics GERIATRIC HEATH MAINTENANCE
- 10. • Driving • Shouldbe discussed in patients with • Dementia • Decline in visual, hearing, and psychomotor skills • Reporting laws exist and vary state to state • Abuse • Reported in 3-8% of older population • Suspicion raised if patient presents with contusions, burns, bite marks, genital or rectal trauma, pressure ulcers, or a BMI <17.5 without clinical explanation • Advance Care Directives • Discussion is appropriate during Health Maintenance Exam focusing on preventative planning GERIATRIC HEATH MAINTENANCE
- 11. • Intensive MultidisciplinaryDiagnostic and Treatment Program • Differing from the Primary Care Clinician’s Geriatric Health Maintenance • Maximizes health with disease and aging • Initiated through referral by PCP
- 12. • Indications forreferral • Age • Major Comorbidities • CHF, Cancer, DQs, Surgery, etc • Psychosocial Disorders • Depression, Social Isolation • Unstable Geriatric Conditions • Dementia, Falls, Functional Disability • Predicted high health care utilization • Change in living situation Comprehensive Geriatric Assessment
- 13. • Major Componentsof the CGA • Functional capacity • Fall risk • Cognition • Mood • Polypharmacy • Social support • Financial concerns • Goals of care • Advanced care preferences Comprehensive Geriatric Assessment
- 14. • Basic Activitiesof Daily Life • Bathing • Dressing • Toileting • Maintaining continence • Grooming • Feeding • Transferring • Instrumental Activities of Daily Life • Shopping for groceries • Driving or using public transportation • Using the telephone • Performing housework • Doing home repair • Preparing meals • Doing laundry • Taking medications • Handling finances Comprehensive Geriatric Assessment • Functional capacity • Ability to perform activities necessary AND desirable in daily life • In the context of living environment and social network
- 15. • Fall risk •Assessment integrated into H/P of all geriatric patients • Cognition • Assessment integrated into H/P of all geriatric patients • Mood • Assessment integrated into H/P of all geriatric patients • Polypharmacy • Clinician review recommended on every visit Comprehensive Geriatric Assessment
- 16. • Social supportand Financial concerns • Brief screening of SoHx indicated • Screen caregivers periodically for depression burnout • Refer to counseling or support groups • Goals of care • Typical CGA patients have limited ability to return to fully healthy/independent lifestyles • Social and Functional goals typically assume priority over healthcare. • Advanced care preferences • Assessment integrated into H/P of all geriatric patients Comprehensive Geriatric Assessment
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