9/8/2017 OBJECTIVES:

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1 OBJECTIVES: To help caregivers indentify geriatric conditions by performing a simplified geriatric assessment to better manage these conditions and prevent or delay their complications. Discuss Geriatric Syndrome common health conditions in older adults that have an impact on quality of life and disability, so these conditions might be indentified by a geriatric assessment and addressed in a person s care or treatment plan. Define Geriatric Assessment and its components, so caregivers can assist in addressing the care needed for successful treatment and prevention of disease and disability in older people. Review a list of topics that geriatric caregivers may choose to assess in order to identify a variety of treatable health problems that could lead to interventions or treatments resulting in better health outcomes for the geriatric client. 1

2 The Geriatric Assessment is a multidimensional, multidisciplinary diagnostic instrument designed to collect data on the medical, psychosocial, and functional capabilities and limitations of elderly patients. The Geriatric Assessment is a diagnostic process and is often used to include both evaluation and management. Five I s of Geriatrics 1. Intellectual Impairement 2. Immobility 3. Instability 4. Incontinence 5. Iatrogenic Disorders (relating to illness caused by medical examination or treatment) Criteria for identifying patients that would benefit from a geriatric assessment: Geriatric Age. The age of 65 is often used, but most people do not need geriatrics expertise in their care until age 70 or 75. Medical comorbidities (presence of two chronic diseases or conditions) existing such as heart failure and cancer. Psychosocial disorders such as, depression or isolation. 2

3 Specific geriatric conditions such as dementia, falls, or functional disability Previous or predicted high health care utilization Consideration of change in living situation (from independent living to assisted living, nursing home, or inhome caregivers) Areas geriatric providers may choose too assess: Current symptoms and illnesses and their functional impact. Current medications, their indications and effects. Relevant past illnesses. Objective measure of overall personal and social functionality. Current and future living environment and its appropriateness to function and prognosis. Family situation and availability. Current caregiver network including its deficiencies and potential. Objective measure of cognitive status. Rehabilitative status and prognosis if ill or disabled. Current emotional health and substance abuse. Nutritional status and needs. Disease factors, screening status and health promotion activities. Services required and received. 3

4 Six essential steps the team will undertake with a Geriatric Assessment: 1. Gather data 2. Discussion among the team, increasingly including the patient and/or caregiver as a member of the team 3. Development, with the patient and/or caregiver, of a treatment plan 4. Implementation of the plan 5. Monitoring the response to the treatment plan 6. Revising the treatment plan Major components of a comprehensive geriatric assessment that should be evaluated during the process are: Functional capacity Fall risk Cognition Mood Polypharmacy Social support Financial concerns Goals of care Advance care preferences Additional components may also be included: Nutrition/weight change Urinary incontinence Sexual function Visions/hearing Dentition Living situation Spirituality 4

5 Nutrition Screening Tool: I have an illness or condition that made me change the kind and/or amount of food I eat. I eat fewer than two meals a day. I eat few fruits, vegetables, or milk products. I have three or more drinks of beer, liquor, or wine almost every day. I have tooth or mouth problems that make it hard for me to eat. I don t always have enough money to buy the food I need. I eat alone most of the time. I take three or more different prescribed or over-thecounter drugs per day. Without wanting to, I have lost or gained 10 lbs. in the last six months. I am not always physically able to shop, cook, and/or feed myself. Functional Status or Capacity Levels BADLs Basic Activities of Daily Living IADLs Instrumental or Intermediate Activities of Daily Living AADLs Advanced Activities of Daily Living BADLs refer to self-care that include: Bathing Dressing Toileting Maintaining continence Grooming Feeding Transferring 5

6 IADLs refer to the ability to maintain an independent household which includes: Shopping for groceries Driving or using public transportation Using the telephone Performing housework Doing home repair Preparing meals Doing laundry Taking medications Handling finances AADLs vary but advance activities include the ability to fulfill societal, community and family roles as well as participate in recreational or occupational task QUESTIONS? 6

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