GERIATRIC ASSESSMENT
Jane Courtney
family
Community support
nurses
Speech therapist
pharmacist
dietician
Multi-disciplinary
team
Multi-disciplinary team
geriatrician
physiotherapist
Local doctor
psychologist
Occupational therapist
World Health Organization definitions of disability.
• Disease—an intrinsic pathology or disorder . . . [which] may
or may not make [itself] evident clinically
• Impairment—a loss or abnormality of structure or function at
the organ system level
• Disability—a restriction or lack of ability to perform an activity
in a normal manner, a disturbance in the performance of daily
tasks
• Handicap—a disadvantage resulting from impairment or
disability that limits or prevents fulfillment of a role that is
normal
PATHOLOGY
(DISEASE)
IMPAIRMENT
(SYMPTOMS & SIGNS)
DISABILITY
(FUNCTIONAL LOSS)
HANDICAP
(SOCIAL CONSEQUENCES)
DIAGNOSES
Rheumatoid arthritis
DISABILITIES
Poor mobility
Pain
Poor hand function
Carcinoma of prostate
Incontinence
TURP
Hot flushes
Radiotherapy
Faecal urgency
Hormonal therapy
Pain
Skeletal metastases
ACTS OF DAILY LIVING (ADL’s)
MOBILITY- independent
with aid (
assist
wheelchair
bedbound
)
TRANSFERS- independent
assist
not
TOILET USE- independent
assist
not
GROOMING- independent
assist
not
SHOWERING- independent
assist
not
DRESSING- independent
assist
not
FEEDING-
CONTINENCE- bladder
bowels
independent
assist
not
COGNITION -
MEMORY
PROBLEM SOLVING
SOCIALISATION
BEHAVIOUR
DOMESTIC FUNCTIONS- SHOPPING
COOKING
CLEANING
TRANSPORT
BARTHEL ADL index
FUNCTIONAL INDEPENDENCE MEASURE (FIM)
MINI MENTAL STATE EXAM MMSE (FOLSTEIN’s)
GERIATRIC DEPRESSION SCALE (GDS)
FIM (motor)
Self-care
A.Self-care
B.Grooming
C.Bathing
D.Dressing upper body
E.Dressing lower body
F.Toileting
Sphincter control
G.Bladder management
H.Bowel management
Mobility (transfer)
I.Bed, chair, wheelchair
J.Toilet
K.Tub, shower
Locomotion
L.Walk/wheelchair
M.Stairs
FIM(cognitive):
Communication
N.Comprehension
O.Expression
Social cognition
P.Social integration
Q.Problem solving
R.Memory
Score: 1 – 7 for each of 18 items (126)
Independence:
7—complete independence (timely, safely)
6—modified independence (device used)
Modified dependence:
5—supervision
4—minimal assistance (>75% of task)
3—moderate assistance (50%-74% of task)
2—maximal assistance (25%-49% of task)
Complete dependence:
1—total assistance (subject performs <25% of task)
MMSE
1 ORIENTATION- TIME
(5)
2 ORIENTATION – PLACE
(5)
3 REGISTRATION
(3)
4 CALCULATION
(5)
5 RECALL
(3)
6 NAMING
(2)
7 “NO IF ANDS OR BUTS”
(1)
8 “3 STAGE COMMAND”
(3)
9 “CLOSE YOUR EYES”
(1)
10 WRITE A SENTENCE
(1)
11 PENTAGONS
(1)
GERIATRIC DEPRESSION SCALE
WHAT DO WE DO WITH THIS ASSESSMENT?
PLAN CARE
Rehabilitation is a problem solving and educational
process aimed at reducing the disability and handicap
experienced by someone as a result of a disease,
always within the limitations of available resources.
(ICIDH quoted in “oxford textbook of geriatrics”.)
1 assess- identify, analyze &measure problems
2 plan- analyze problem(s) & set goals
3 treat- intervene to reduce disability & handicap
4 care- intervene to alleviate consequences of
disability
5 evaluate- check effectiveness
AGED CARE ASSESSMENT TEAM (ACAT)
ASSESS FOR APPROVAL OF GOVERNMENT FUNDING FOR CARE
CO-LOCATED IN GERIATRIC DEPARTMENTS.