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Comprehensive
Geriatric Assessment
DR. APARNA SEN CHAUDHARY
1
Introduction
 “Geriatrics” is the science that deals with study of disease
and their treatment peculiar to old age.
 United Nations (1980) considered 60 years as the age of
transition to the elderly age group
1. “Early old age - up to 75 years (elderly)
2. “Late old age - above 75 years (very elderly)
2
Introduction
 “Gerontology” is the study of the physical and
psychological changes which are incident to old age.
3
Clinical Gerontology
Social Gerontology
Experimental Gerontology
Geriatrics Gynaecology
Introduction
WORLD
By 2020, the number of people aged 60 years and
older will outnumber children younger than 5 years.
By 2050, population aged 60 years and older is
expected to total 2 billion, up from 900 million in 2015.
In 2050, 80% of older people will be living in low- and
middle-income countries.
4
Source : Ageing and health. Factsheet. World Health Organization.2015
5
Introduction
INDIA –
 Accounts for 7.4% of total population in 2001, 8.6% in 2011,
and is projected to increase to 19% by the year 2050.
 Poised to become home to second largest number of older
persons.
 Old Age Dependency Ratio increased from 10.9% in 1961 to
14.2% in 2011.
6
7
96.30
million
(2011)
133.32
million
(2021)
178.59
million
(2031)
236.01
million
(2041)
300.96
million
(2051)
Source : Operational Guidelines. National Programme for Health Care of the Elderly (NPHCE). Directorate
General of Health Services. Ministry of Health & Family Welfare. Government of India. 2011.
Geriatric Health
Problems
Due to the Ageing
Process
Problems
associated with
long term Illness
Psychological
Problems
8
Geriatric Health Problems
 Problems due to the Ageing process
a) Senile cataract
b) Glaucoma
c) Nerve Deafness
d) Osteoporosis
e) Emphysema
f) Failure of special senses
g) Changes in Mental outlook
9
Geriatric Health Problems
 Problems associated with Long-Term Illness
a) Degenerative Disease of Heart and Blood Vessels
b) Cancer
c) Accidents
d) Diabetes
e) Disease of Locomotor System
f) Respiratory Illness
g) Genitourinary System
10
Geriatric Health Problems
 Psychological Problems
a) Mental Changes
b) Sexual Adjustments
c) Emotional Disorders
11
Geriatric Assessment - Definition
 “A Multidimensional interdisciplinary diagnostic process
focused on determining a frail older person’s medical,
psychological and functional capability in order to develop
a coordinated and integrated plan for treatment and long
term follow up.”
12
Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impact of geriatric evaluation and management programs on defined outcomes: overview of
the evidence. J Am Geriatr Soc.1991;39:8-16S.
Geriatric Assessment - Use
 Used to –
 Develop treatment and long-term follow-up plans,
 Arrange for primary care and rehabilitative services,
 Organize and facilitate the intricate process of case
management,
 Determine long-term care requirements
 Make the best use of health care resources.
13
Implications of Geriatric Assessment
 Improve the assessment of the medical and the
psychological Problems
 To provide Therapy and Rehabilitation services
 To determine optimal posttherapy placement for an
independent functioning
 To provide healthcare both by Healthcare Professionals
and care takers
14
Geriatric Assessment – Why it is important?
 Focuses on elderly individuals with complex problems,
 Emphasizes functional status and quality of life, and
 Frequently takes advantage of an interdisciplinary team of
providers.
 Effectively addresses The "Five I's of Geriatrics” i.e.,
1. intellectual impairment,
2. immobility,
3. instability,
4. incontinence and
5. iatrogenic disorders.
15
Comprehensive Geriatric Assessment
Comprehensive
Geriatric
Assessment
Medical
Psychological
Social/
Environmental
Functional
16
Comprehensive Geriatric Assessment
 Medical
 Comorbidities
 Continence
 Fall risk
 Nutritional Status
 Medication
 Advanced care
 Vision and hearing
 Functional
 Gait and balance
 Mobility and transfers
 Basic activities of daily living,
e.g. feeding, washing, toileting
 Instrumental activities of daily
living, e.g. shopping, cooking,
 Advanced activities of daily
living, e.g. hobbies
17
Comprehensive Geriatric Assessment
 Psychological
 Mood
 Cognition
 Ideas, concerns and
expectations
 Social or Environmental
 Formal care support
 Home safety and
appropriateness
 Social network providing
informal support
 Accessibility to local
resources and Financial
assessment
18
Comprehensive Geriatric Assessment
Medical Geriatric
Assessment
Medical History
Standard Medical
Examination
19
Periodic Geriatric Assessment
Detailed health assessment
once they are 45-50 years
Once in 5 years till 65 years
of age
Thereafter every year or at
least once in 2 years
20
Bhalwar R, Gupta RK, Kunte R, Tilak R, Vaidya R. Textbook of Public Health and Community Medicine. Pune: Department of Community Medicine, Armed Forces Medical College
in collaboration with WHO India Office; 2009.
Comprehensive Geriatric Assessment
 Medical History
1. Demographic details
2. Chief complaints
3. Present Illness
4. Past history
5. Social History
6. Family History
21
Comprehensive Geriatric Assessment
 Medical Examination
1. Visual Impairment/ complaints
2. Locomotive disorders, joints, muscles
3. Neurological complaints
4. Cardiovascular disease
5. Respiratory disorders
6. Weight Changes
7. Gastro-intestinal/ Abdominal disorder
8. Psychiatric problem
9. Hearing loss
10.Genitourinary disorder
22
23
24
25
Geriatric Assessment Tools
 Visual Impairment
26
Visual
Acuity
• Snellen
Test
• Near Test
Visual Field
• Confrontat
ion test
• Perimetry
Glaucoma
• Tonometry
• Pachymetry
Macular
Degeneration
• Amsler Grid
Test
Geriatric Assessment Tools
 Falls/Gait Disturbance
27
Fall Screening Test
• Timed up and go test
• Single leg stand
• Single chair rise
Balance Assessment
Tools
• Timed chair rise
• Tandem stance
• 360⁰ turn protocol
• Alternate step test
Geriatric Assessment Tools
 Neurological Complaints
1. Mini Mental State Examination
2. Abbreviated mental status test
3. Clock drawing
4. Mini-cog
5. Montreal Cognitive Assessment
28
Geriatric Assessment Tools
 Cardiovascular Disease
1. Lipid Screening
2. Lipoprotein (a), Apolipoproteins A1 and B
3. Inflammation biomarkers
a. Homocysteine
b. Fibrinogen
c. Natriuretic peptides (BNP and NT-proBNP)
29
Geriatric Assessment Tools
 Hearing Loss
1. Whispered Voice Test
2. Calibrated finger rub auditory screening test (CALFRAST)
3. Watch tick test
4. Handheld audiometer
30
Geriatric Assessment Tools
 Genitourinary
1. 2-item questionnaire
2. Single question
3. The 3IQ questionnaire
4. Urine Dipstick
5. Digital rectal examination
6. Post-void residual volume
7. Prostate Specific Antigen
31
Geriatric Assessment Tools
 Psychiatric Problems
1. Geriatric Depression Scale,
2. Hospital Anxiety and Depression Scale, and
3. Patient Health Questionnaire.
32
Geriatric Assessment Tools
 Weight Changes
1. Nutritional Health Checklist
2. Detailed Dietary Assessment using 24-hour recall
3. Physical Examination – over-consumption or inadequate
nutrition
4. Laboratory test
33
34Nutritional Health Checklist
Comprehensive Geriatric Assessment
 Functional Assessment Tools
1. As a measure of overall impact of health conditions in the
context of a patient’s environment and social support
system
2. This can be assessed at 3 levels:
a) Basic activities of daily living (BADLs),
b) Instrumental activities of daily living (IADLs), and
c) Advanced activities of daily living (AADLs).
35
36Basic activities of daily living index
Comprehensive Geriatric Assessment
 Social Assessment
a) There is a great deal of interdependency between patients’
social situations and their functional status.
b) Living arrangements, financial security, transportation,
access to medical services
c) Psychosocial/ interpersonal relations
d) A variety of private and public resources
e) Home assessments
37
Comprehensive Geriatric Assessment
 Polypharmacy
 This is a notable source of harm in older people.
 Increased susceptibility to adverse drug reactions.
 Comprehensive geriatric assessment should always
Process of drug rationalisation.
Adequate monitoring following any change to
medication
38
Comprehensive Geriatric Assessment
 Advance care planning
 Comprehensive geriatric assessment should aim to elicit
health-care preferences and engage in discussion around
advance care planning.
 Discussions must be sensitive, relevant, open, and centred
on the individual’s wishes.
 The process may result in a number of formalized
outcomes.
39
Comprehensive Geriatric Assessment
 Challenges
• Unfamiliar concept
• It is often incompletely executed, therefore negating its
benefits.
• Lack of relevant staff training
• Insufficient time and resources
• Lack of continuity of assessment
• Absence of a consistent team leader
40
41

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Comprehensive geriatric assessment

  • 2. Introduction  “Geriatrics” is the science that deals with study of disease and their treatment peculiar to old age.  United Nations (1980) considered 60 years as the age of transition to the elderly age group 1. “Early old age - up to 75 years (elderly) 2. “Late old age - above 75 years (very elderly) 2
  • 3. Introduction  “Gerontology” is the study of the physical and psychological changes which are incident to old age. 3 Clinical Gerontology Social Gerontology Experimental Gerontology Geriatrics Gynaecology
  • 4. Introduction WORLD By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years. By 2050, population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. In 2050, 80% of older people will be living in low- and middle-income countries. 4 Source : Ageing and health. Factsheet. World Health Organization.2015
  • 5. 5
  • 6. Introduction INDIA –  Accounts for 7.4% of total population in 2001, 8.6% in 2011, and is projected to increase to 19% by the year 2050.  Poised to become home to second largest number of older persons.  Old Age Dependency Ratio increased from 10.9% in 1961 to 14.2% in 2011. 6
  • 7. 7 96.30 million (2011) 133.32 million (2021) 178.59 million (2031) 236.01 million (2041) 300.96 million (2051) Source : Operational Guidelines. National Programme for Health Care of the Elderly (NPHCE). Directorate General of Health Services. Ministry of Health & Family Welfare. Government of India. 2011.
  • 8. Geriatric Health Problems Due to the Ageing Process Problems associated with long term Illness Psychological Problems 8
  • 9. Geriatric Health Problems  Problems due to the Ageing process a) Senile cataract b) Glaucoma c) Nerve Deafness d) Osteoporosis e) Emphysema f) Failure of special senses g) Changes in Mental outlook 9
  • 10. Geriatric Health Problems  Problems associated with Long-Term Illness a) Degenerative Disease of Heart and Blood Vessels b) Cancer c) Accidents d) Diabetes e) Disease of Locomotor System f) Respiratory Illness g) Genitourinary System 10
  • 11. Geriatric Health Problems  Psychological Problems a) Mental Changes b) Sexual Adjustments c) Emotional Disorders 11
  • 12. Geriatric Assessment - Definition  “A Multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long term follow up.” 12 Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impact of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc.1991;39:8-16S.
  • 13. Geriatric Assessment - Use  Used to –  Develop treatment and long-term follow-up plans,  Arrange for primary care and rehabilitative services,  Organize and facilitate the intricate process of case management,  Determine long-term care requirements  Make the best use of health care resources. 13
  • 14. Implications of Geriatric Assessment  Improve the assessment of the medical and the psychological Problems  To provide Therapy and Rehabilitation services  To determine optimal posttherapy placement for an independent functioning  To provide healthcare both by Healthcare Professionals and care takers 14
  • 15. Geriatric Assessment – Why it is important?  Focuses on elderly individuals with complex problems,  Emphasizes functional status and quality of life, and  Frequently takes advantage of an interdisciplinary team of providers.  Effectively addresses The "Five I's of Geriatrics” i.e., 1. intellectual impairment, 2. immobility, 3. instability, 4. incontinence and 5. iatrogenic disorders. 15
  • 17. Comprehensive Geriatric Assessment  Medical  Comorbidities  Continence  Fall risk  Nutritional Status  Medication  Advanced care  Vision and hearing  Functional  Gait and balance  Mobility and transfers  Basic activities of daily living, e.g. feeding, washing, toileting  Instrumental activities of daily living, e.g. shopping, cooking,  Advanced activities of daily living, e.g. hobbies 17
  • 18. Comprehensive Geriatric Assessment  Psychological  Mood  Cognition  Ideas, concerns and expectations  Social or Environmental  Formal care support  Home safety and appropriateness  Social network providing informal support  Accessibility to local resources and Financial assessment 18
  • 19. Comprehensive Geriatric Assessment Medical Geriatric Assessment Medical History Standard Medical Examination 19
  • 20. Periodic Geriatric Assessment Detailed health assessment once they are 45-50 years Once in 5 years till 65 years of age Thereafter every year or at least once in 2 years 20 Bhalwar R, Gupta RK, Kunte R, Tilak R, Vaidya R. Textbook of Public Health and Community Medicine. Pune: Department of Community Medicine, Armed Forces Medical College in collaboration with WHO India Office; 2009.
  • 21. Comprehensive Geriatric Assessment  Medical History 1. Demographic details 2. Chief complaints 3. Present Illness 4. Past history 5. Social History 6. Family History 21
  • 22. Comprehensive Geriatric Assessment  Medical Examination 1. Visual Impairment/ complaints 2. Locomotive disorders, joints, muscles 3. Neurological complaints 4. Cardiovascular disease 5. Respiratory disorders 6. Weight Changes 7. Gastro-intestinal/ Abdominal disorder 8. Psychiatric problem 9. Hearing loss 10.Genitourinary disorder 22
  • 23. 23
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  • 26. Geriatric Assessment Tools  Visual Impairment 26 Visual Acuity • Snellen Test • Near Test Visual Field • Confrontat ion test • Perimetry Glaucoma • Tonometry • Pachymetry Macular Degeneration • Amsler Grid Test
  • 27. Geriatric Assessment Tools  Falls/Gait Disturbance 27 Fall Screening Test • Timed up and go test • Single leg stand • Single chair rise Balance Assessment Tools • Timed chair rise • Tandem stance • 360⁰ turn protocol • Alternate step test
  • 28. Geriatric Assessment Tools  Neurological Complaints 1. Mini Mental State Examination 2. Abbreviated mental status test 3. Clock drawing 4. Mini-cog 5. Montreal Cognitive Assessment 28
  • 29. Geriatric Assessment Tools  Cardiovascular Disease 1. Lipid Screening 2. Lipoprotein (a), Apolipoproteins A1 and B 3. Inflammation biomarkers a. Homocysteine b. Fibrinogen c. Natriuretic peptides (BNP and NT-proBNP) 29
  • 30. Geriatric Assessment Tools  Hearing Loss 1. Whispered Voice Test 2. Calibrated finger rub auditory screening test (CALFRAST) 3. Watch tick test 4. Handheld audiometer 30
  • 31. Geriatric Assessment Tools  Genitourinary 1. 2-item questionnaire 2. Single question 3. The 3IQ questionnaire 4. Urine Dipstick 5. Digital rectal examination 6. Post-void residual volume 7. Prostate Specific Antigen 31
  • 32. Geriatric Assessment Tools  Psychiatric Problems 1. Geriatric Depression Scale, 2. Hospital Anxiety and Depression Scale, and 3. Patient Health Questionnaire. 32
  • 33. Geriatric Assessment Tools  Weight Changes 1. Nutritional Health Checklist 2. Detailed Dietary Assessment using 24-hour recall 3. Physical Examination – over-consumption or inadequate nutrition 4. Laboratory test 33
  • 35. Comprehensive Geriatric Assessment  Functional Assessment Tools 1. As a measure of overall impact of health conditions in the context of a patient’s environment and social support system 2. This can be assessed at 3 levels: a) Basic activities of daily living (BADLs), b) Instrumental activities of daily living (IADLs), and c) Advanced activities of daily living (AADLs). 35
  • 36. 36Basic activities of daily living index
  • 37. Comprehensive Geriatric Assessment  Social Assessment a) There is a great deal of interdependency between patients’ social situations and their functional status. b) Living arrangements, financial security, transportation, access to medical services c) Psychosocial/ interpersonal relations d) A variety of private and public resources e) Home assessments 37
  • 38. Comprehensive Geriatric Assessment  Polypharmacy  This is a notable source of harm in older people.  Increased susceptibility to adverse drug reactions.  Comprehensive geriatric assessment should always Process of drug rationalisation. Adequate monitoring following any change to medication 38
  • 39. Comprehensive Geriatric Assessment  Advance care planning  Comprehensive geriatric assessment should aim to elicit health-care preferences and engage in discussion around advance care planning.  Discussions must be sensitive, relevant, open, and centred on the individual’s wishes.  The process may result in a number of formalized outcomes. 39
  • 40. Comprehensive Geriatric Assessment  Challenges • Unfamiliar concept • It is often incompletely executed, therefore negating its benefits. • Lack of relevant staff training • Insufficient time and resources • Lack of continuity of assessment • Absence of a consistent team leader 40
  • 41. 41

Hinweis der Redaktion

  1. In 2050, 80% of older people will be living in low- and middle-income countries.  the world population is the total number of humans currently living. As of August 2016 , it was estimated at 7.4 billion.
  2.  the world population is the total number of humans currently living. As of August 2016 , it was estimated at 7.4 billion. Projection of numbers of 60+
  3. the standard medical evaluation works reasonably well in most other populations, it tends to miss some of the most prevalent problems faced by the elder patient Its differs from standard treatment because 1. focu
  4. For the medical assessment, the standard physical examination and past medical history-taking is augmented by an evaluation of possible geriatric syndromes including hearing impairment, cognitive impairment, functional status, depression, falls, gait disorder, and incontinence. The social assessment involves an in-depth history-taking, which may involve obtaining information from collateral sources such as family, neighbours, and friends. The psychological assessment includes screening for depression, which complements a cognitive assessment including screening for dementia.
  5. 1. 2-item questionnaire : (1) ‘‘In the last year, have you ever lost urine and gotten wet?’’ If so, (2) ‘‘Have you lost urine on 6 separate days?’’ 2. , ‘‘Have you had urinary incontinence that is bothersome enough that you would like to know how it could be treated?’’ 3. The 3IQ questionnaire differentiate between urinary stress and urge incontinence using self-report questions
  6. Lab test – Albumin, cholesterol, blood glucose, hb
  7. A variety of private and public resources can provide further assessment if the initial screening indicates a problem. Home assessments provided by home health social worker can also help further reveal levels of support at home
  8. Prescribing four or more drugs Process of drug rationalisation, with the underpinning question being: ‘does my patient really need to be taking this?’ However, it is essential to have a thorough drug history, with GP and pharmacist input, before stopping a drug. In addition, the patient should be adequately monitored following any change to medication and the GP informed of the change, along with the reasoning behind it.
  9. Increased awareness, education and effective re-allocation of resources to match the growing socioeconomic burden of geriatric illness are required to address these challenge and allow integration of the comprehensive geriatric assessment into daily clinical practice