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GERIATRIC ASSESSMENT Jane Courtney. family. Community support. nurses. Speech therapist. pharmacist. dietician. Multi-disciplinary team. Multi-disciplinary team. geriatrician. physiotherapist. Local doctor. Occupational therapist. psychologist.

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GERIATRIC ASSESSMENT Jane Courtney


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slide2

family

Community support

nurses

Speech therapist

pharmacist

dietician

Multi-disciplinary team

Multi-disciplinary team

geriatrician

physiotherapist

Local doctor

Occupational therapist

psychologist

slide3

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

slide4

PATHOLOGY

(DISEASE)

IMPAIRMENT

(SYMPTOMS & SIGNS)

DISABILITY

(FUNCTIONAL LOSS)

HANDICAP

(SOCIAL CONSEQUENCES)

slide5

DIAGNOSES

DISABILITIES

Rheumatoid arthritis

Poor mobility

Pain

Poor hand function

slide6

Carcinoma of prostate

TURP

Radiotherapy

Hormonal therapy

Skeletal metastases

Incontinence

Hot flushes

Faecal urgency

Pain

slide8

COGNITION - MEMORY

PROBLEM SOLVING

SOCIALISATION

BEHAVIOUR

DOMESTIC FUNCTIONS- SHOPPING

COOKING

CLEANING

TRANSPORT

slide9

BARTHEL ADL index

FUNCTIONAL INDEPENDENCE MEASURE (FIM)

MINI MENTAL STATE EXAM MMSE (FOLSTEIN’s)

GERIATRIC DEPRESSION SCALE (GDS)

slide10

FIM (motor)

Self-care 

A.Self-care 

B.Grooming 

C.Bathing 

D.Dressing upper body 

E.Dressing lower body 

F.Toileting 

slide11

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

slide12

FIM(cognitive): 

Communication 

N.Comprehension 

O.Expression

Social cognition 

P.Social integration 

Q.Problem solving 

R.Memory

slide13

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)

slide14

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)

slide17

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”.)

slide18

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

slide19

AGED CARE ASSESSMENT TEAM (ACAT)

ASSESS FOR APPROVAL OF GOVERNMENT FUNDING FOR CARE

CO-LOCATED IN GERIATRIC DEPARTMENTS.