Summary

A geriatric assessment can identify frequent problems, thus leading to earlier interventions for the common medical and social concerns of the elderly population. It is important to remember, however, that patients may underreport medical problems because they worry about losing their independence. Patients may also be reluctant to repeat their health concerns to their primary care physician because they fear being perceived as having an emotional or psychiatric illness. Often, older patients will rationalize their symptoms as being a "normal" component of aging.

The key to a successful geriatric assessment is to establish trust and effective communication between the patient and the physician. Allotting for adequate time during appointments and, if needed, scheduling frequent office visits are essential to the gathering of information. Inquiring about recent socioeconomic changes, functional losses, or life transitions is also important. The physician should obtain the patient's medical records before the first visit. A questionnaire targeted to the geriatric assessment domains should be completed by the patient, with family assistance if needed

Total

e or more

(Figure 4-2). Language, education, social support, economic status, and cultural/ethnic factors play a vital role in the patient's health care outcome. A multidisciplinary approach is used to interventions and management. Preserving function and maintaining quality of life are the primary goals of the geriatric assessment (Miller et al., 2000).

Falls

Key Points

• Falls result in significant morbidity, mortality, and functional decline.

• Patients should be asked about history of falls and balance issues.

• Medication review is a key component of falls assessment.

• Multifactorial interventions can reduce the rate of falls.

• Exercise programs that focus on strength and balance training are most effective in preventing falls.

Epidemiology

Falls result in significant morbidity and mortality as well as an increased rate of nursing home placement. Each year, approximately 30% of persons over age 65 fall at least once, and the incidence increases with age. Up to 10% of falls result in serious injury. Falls are the leading cause of injury-related deaths in people over 65 years (CDC, 2005). In the United States, hip fractures currently account for more than 300,000

GERIATRIC HEALTH QUESTIONNAIRE

Date:

Birthdate:

Hosp #:

Name:

Address:

INSTRUCTIONS: PLEASE CIRCLE ANSWERS.

1. General health: In general, would you say your health is:

How much bodily pain have you had during the past 4 weeks? None / Very mild / Mild / Moderate / Severe / Very severe

2. Activities of daily living: Are you (I) independent (can do by myself); (A) require assistance (need help from another person); or (D) dependent (cannot do at all) with each of the following tasks?

2. Activities of daily living: Are you (I) independent (can do by myself); (A) require assistance (need help from another person); or (D) dependent (cannot do at all) with each of the following tasks?

Walking

I A

D

Using telephone

I A

D

Dressing

I A

D

Shopping

I A

D

Bathing

I A

D

Preparing meals

I A

D

Eating

I A

D

Housework

I A

D

Toileting

I A

D

Taking medications

I A

D

Driving

I A

D

Managing finances

I A

D

3. Geriatric review of systems:

3. Geriatric review of systems:

4. Do you live with anyone? Yes / No If yes, who? Spouse / Child / Other / Relative / Friend Who would help you in an emergency?_

Who would help you with health care decisions if you were not able to communicate your wishes? 5. How many medicines do you take, including prescribed, over the counter, and vitamins?_

What is your system for taking your medications? Pill box / Family help / List or chart / None

6. Are you sexually active? Yes / No

7. Has anyone intentionally tried to harm you? Yes / No

8. Have you had a shot to prevent pneumonia? Yes / No

9. Please draw the face of a clock with all the numbers and the hands set to indicate 10 minutes after 11 o'clock.

Memory: 3 item recall after 1 minute

Patient signature_

Reviewing physician_

_Date

_Date

Figure 4-2 Geriatric health questionnaires assist in gathering pertinent information regarding the functioning of the elderly patient.

hospitalizations, with a 1-year mortality rate of up to 33% (Sattin, 1992; Tinetti et al., 1998). By 2050, it is estimated that the worldwide number of hip fractures will rise to 6.26 million. Direct medical costs related to falls in adults age 65 or older exceeded $19 billion in 2000 (Stevens et al., 2006).

Falls also cause functional limitations by both direct injury and indirect psychological consequences. Postfall anxiety leads to loss of self-confidence in ambulation and self-imposed limitations in activity. Postfall anxiety syndrome can also result in depression, social isolation, and increased risk of falls from deconditioning. Because the cause of falls is often multifactorial, the assessment and interventions target several areas (Nevitt et al., 1989).

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