GERIATRIC ASSESSMENT

Jane Courtney

Multi-disciplinary team

Local doctor

nurses

Speech therapist

dietician

physiotherapist

Occupational therapist

pharmacist

Community supportfamily

geriatrician

Multi-disciplinary team

psychologist

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 DISABILITIES

Rheumatoid arthritis Poor mobility

Pain

Poor hand function

Carcinoma of prostate

TURP

Radiotherapy

Hormonal therapy

Skeletal metastases

Incontinence

Hot flushes

Faecal urgency

Pain

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- independent

assist

not

CONTINENCE- bladder

bowels

ACTS OF DAILY LIVING (ADL’s)

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)

 Self-care   

A.Self-care 

B.Grooming 

C.Bathing 

D.Dressing upper body 

E.Dressing lower body 

F.Toileting 

FIM (motor)

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.