Podcast
Questions and Answers
What is the main focus of the Medicare Annual Wellness Visit documentation requirements?
What is the main focus of the Medicare Annual Wellness Visit documentation requirements?
Which cognitive assessment tools are mentioned in the content for evaluating cognitive function?
Which cognitive assessment tools are mentioned in the content for evaluating cognitive function?
For a patient showing signs of malnutrition, what is the recommended referral from the assessment content?
For a patient showing signs of malnutrition, what is the recommended referral from the assessment content?
What should be assessed if a patient reports urinary incontinence according to the assessment guidelines?
What should be assessed if a patient reports urinary incontinence according to the assessment guidelines?
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Which of the following screening methods is not associated with the assessment of pain?
Which of the following screening methods is not associated with the assessment of pain?
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What screening tool is recommended for assessing anxiety in patients?
What screening tool is recommended for assessing anxiety in patients?
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If a patient experiences two or more injurious falls in the past year, which assessment should be conducted?
If a patient experiences two or more injurious falls in the past year, which assessment should be conducted?
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Which vital sign assessment is specifically required during the Medicare Annual Wellness Visit?
Which vital sign assessment is specifically required during the Medicare Annual Wellness Visit?
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What is an important consideration when assessing a patient's life expectancy who is over 10 years?
What is an important consideration when assessing a patient's life expectancy who is over 10 years?
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Which of the following conditions of the elderly is associated with vision issues?
Which of the following conditions of the elderly is associated with vision issues?
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What does a score of 26 or above on the MOCA signify?
What does a score of 26 or above on the MOCA signify?
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Which of the following best describes a Stimulus-bound Response often seen in dementia patients?
Which of the following best describes a Stimulus-bound Response often seen in dementia patients?
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Which assessment is primarily used to evaluate a patient's ability to perform daily living activities?
Which assessment is primarily used to evaluate a patient's ability to perform daily living activities?
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What is the normal requirement for the Clock Drawing Test to be considered valid?
What is the normal requirement for the Clock Drawing Test to be considered valid?
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Which condition is likely characterized by neglect and spatial deficits?
Which condition is likely characterized by neglect and spatial deficits?
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Study Notes
Comprehensive Exam
- A comprehensive exam should include a normal history and physical exam along with diagnostic work-up.
- Assess prognosis, patient’s values and preferences, and ability to function independently.
- When considering a patient's prognosis, determine if they have a life expectancy greater than 10 years, and consider their ability to improve, quality of life, and harms versus benefits if their life expectancy is less than 10 years.
Vision
- Many conditions of elderly people affect their vision, including presbyopia, cataracts, glaucoma, and macular degeneration.
Hearing
- To assess hearing, use a finger rub, natural speaking across the room, Weber and Rinne tests.
- Referral to an audiologist may be necessary.
- Use caution when recommending hearing aids.
Cognition
- Use the MMSE or MOCA, mini-cog, and animal naming tests to screen for cognitive impairment.
- Animal naming test (consider at least 14 in one minute)
- MOCA: A score of 26 or above is considered normal.
- Clock Drawing Test: Have patients draw a clock with the hands at 11:10. There should be a large circle on a clean piece of paper and the hands should be on opposite sides of the clock.
- Common clock drawing test responses include:
- Stimulus-bound Response: Commonly seen in Alzheimer's disease and is a marker for executive function deficits.
- Perseveration and Pull To Stimulus: Neglect vs. Hemianopsia
- Neglect and Spatial Deficits: Parietal Cortical Lesions
- Conceptual Deficits: Lateral temporal lobes
Mini-Cog
- Recall: Test the patient on three words (Apple, Table, and Penny) and document their recall after the clock drawing test.
- Clock Drawing
- Interpretation: a score of 0-2 is positive for dementia, while a score of 3-5 indicates a negative screen for dementia.
Functional Assessment
-
IADLs:
- Writing
- Reading
- Cooking
- Cleaning
- Shopping
- Doing laundry
- Climbing stairs
- Using the telephone
- Managing medication
- Managing money
- Ability to perform paid employment duties or outside work (e.g., gardening)
- Ability to travel (using public transportation, going out of town)
-
Basic ADLs:
- Feeding
- Dressing
- Ambulation
- Toileting
- Bathing
- Transfer (from bed and toilet)
- Continence
- Grooming
- Communication
-
Pain Assessment: Use pain scales.
-
Nutritional Assessment: Assess weight, BMI, skin folds, waist:hip ratio, and upper arm circumference
Sensitivity and Specificity of Cognitive Testing
- MOCA: Assess sensitivity and specificity.
- MMSE: Assess sensitivity and specificity.
- Clock Drawing Test: Assess sensitivity and specificity.
Medicare Annual Wellness Visit
- This visit can be carried out by a physician, PA, NP clinical nurse specialist, or other health professional under the direct supervision of a physician.
- Documentation of elements indicated in previous tables along with the following must be included in initial and subsequent visits:
- Family history
- List of current providers
- A written 5- to 10-year schedule of screening activities based on USPSTF or CDC recommendations
- List of risk factors and conditions for which primary, secondary, and tertiary preventive interventions are being applied
- BP measurement
Assessment Domain, Screening Methods, Further Assessments if Screen Positive
- Medical Illnesses: Include a history and physical exam, additional targeted PE, lab, and imaging. Consider the prognosis.
- Medications: Medication review and reconciliation, pharmacy referral/coordination.
- Nutrition: Inquire about weight loss (>10 lbs in the past 6 months) and calculate BMI. Assess dietary history and consider a malnutrition evaluation. Refer to a dietitian.
- Dentition: Conduct an oral exam and refer to a dentist.
- Hearing: Use an audioscope, Weber/Rinne, and whisper test. Conduct an ear exam and refer to an audiology specialist.
- Vision: Inquire about vision changes. Use a Snellen chart and conduct an eye exam. Refer to an ophthalmologist.
- Pain: Inquire about pain and use pain inventories.
- Urinary Incontinence: Inquire if the patient has lost urine >5 times in the past year, and refer to urology/urogynecology if necessary.
- Depression: Use PHQ-2, PHQ-9, and refer to psychiatry/neuropsychology if needed.
- Anxiety: Use GAD-2, GAD-7, and refer to psychiatry/neuropsychology as needed.
- Functional Status: Assess ADLs/IADLs and refer to PT/OT.
- Balance and Gait: Conduct a "Get Up and Go" test, Romberg, orthostatic, semitandem standing, formal gait evaluation, and assess gait speed. Possible referral to orthotics/PT
- Falls: If 2 or more injurious falls have occurred in the past year or if the patient is afraid to fall because of balance or walking problems, consider a formal gait evaluation, gait speed assessment, and referral to orthotics/PT
- Life Sustaining Treatments: Inquire about the patient’s preferences regarding life-sustaining treatments. Complete a MOST/DNR, hold a family conference, and consider a legal referral if necessary..
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Description
Test your knowledge on conducting a comprehensive geriatric assessment, including vital aspects such as vision, hearing, and cognition. This quiz covers the essential diagnostic tools and considerations for evaluating elderly patients, incorporating prognosis, patient values, and specific assessments for common geriatric conditions.
