Geriatric Assessment Overview

Geriatric Assessment

• Aims: to recognize common geriatric disorders, plan effective treatment programs, improve overall health and functional outcomes, reduce vulnerability to subsequent illness, and improve quality of life.
• Function: Physical function (gait and balance, self-care), cognitive function (memory, reasoning, judgment, life-maintenance), psychosocial function (depression, mental health, caregiver support, financial resources).
• Instrumental Activities of Daily Living (IADLs): Shopping, housekeeping, accounting, food prep, transportation.
• Activities of Daily Living (ADLs): Dressing, eating, ambulating, toileting, hygiene, bathing
• Importance of ADLs/IADLs: predict hospital outcomes, functional decline, length of stay, institutionalization.
• Assessment: functional tasks (walking, dressing), standardized tests, performance-based testing
• Best test: a "real world" performance test is easy to perform in an office setting and evaluate.

Timed "Get Up and Go" Test

• Patient sits in a chair, rises, walks 10 feet, turns, returns to chair.
• < 20 seconds is considered normal, > 30 seconds indicates functional dependence.
• High risk for falls.

Chair Rise Test

• Standard chair with arms.
• Patient rises from the chair without support.
• <15 seconds for 5 repetitions is normal.

Cognitive Evaluation

• Prevalence of cognitive impairment: 3% at 65, doubling every 5 years.
• Causes of cognitive impairment: delirium, dementia, depression.

Mini-Cog Test

• 3-item recall after clock drawing task.
• Easy to administer with high sensitivity and specificity.
• Not as dependent on education or language.

Clock Drawing Test

• Test for cognitive impairment.
• Assess recall and cognitive speed with 3 items.

Depression Screening

• Single question: "Do you often feel sad or depressed?"
• 2-item screening assesses depressed mood and anhedonia (lack of interest or pleasure in activities).
• Geriatric Depression Scale (GDS) screen for depression, with >5 points suggesting possible depression.

Geriatric Assessment - Other Information

• Folstein Mini-Mental State Exam: (MMSE) a 30-point questionnaire used to screen for cognitive impairment.
• Interpretation of Scores: Scores <24 are considered abnormal.
• Risk for Falls: factors like leg weakness, gait deficit are associated with increased fall risk. A relative risk score for each is given.