GERIATICS ASSESSMENT

• COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) is a multidimensional interdisciplinary assessment for evaluating the medical, psychological, physical functions and socioeconomic problems to detect unidentified and potentially reversible problems and develop a coordinated and integrated management plan for treatment and long-term care plan."
• FRAILTY is Defined as an aging-related syndrome of physiological decline, characterized by marked vulnerability to adverse health outcomes.
• WHO SHOULD HAVE CGA? Older adults identified as being FRAIL or at risk of frailty
• 3 steps process of CGA 1. SCREENING AND SELECTION OF APPROPRIATE PATIENTS 2. ASSESSMENT AND DEVELOPMENT OF RECOMMENDATION 3. IMPLEMENTING RECOMMENDATIONS FROM THE COMPREHENSIVE GERIATRIC ASSESSMENT
• • Core Team Members evaluates all patients. like Physician - Nurse - Social Worker
• Extended members like Rehabilitation therapists -Psychologists - Psychiatrists -Dietitians -Pharmacists -Other health professionals
• DOMAINS OF COMPREHENSIVE GERIATRICS ASSESSMENT MEDICAL ASSESSMENT • COGNITIVE FUNCTION • AFFECTIVE DISORDERS • VISUAL IMPAIRMENTS • HEARING IMPAIRMENTS • DENTAL HEALTH FUNCTIONAL STATUS • NUTRITIONAL STATUS • GAIT AND BALANCE IMPAIRMENT • SOCIAL SUPPORT • ENVIRONMENT • ADVANCE DIRECTIVES
• Medical Assessment HISTORY OF PRESENT ILLNESS • PAST HEALTH HISTORY • FAMILY HISTORY • PAIN HISTORY • PSYCHOLOGICAL HISTORY • REVIEW OF SYSTEMS, COGNITIVE FUNCTION, Affective Disorders,
• 3 LEVELS OF EXAMINATION FUNCTION. Basic, Instrumental, Advanced
• BASIC Activities of Daily Living (BADL) : refer to those functions that are necessary, but not sufficient, for maintaining an independent living status.
• INSTRUMENTAL Activities of Daily Living (IADL): necessary to maintain an independent household
• ADVANCED Activities of Daily Living (AADL): Highest leveL
• Common Physical Findings And Their Potential Significance In Geriatrics • Bruising • Ulcerations, Diminished Turgor
• • Entropion (inversion of lower lid margins)
• • Ectropion (eversion of eye)
• Arcus senilis ( a white ring at the limbus)
• Presbycusis (Hearing Loss)
• Painful, inflamed, fissured lesions at the lip commissures (Angular Cheilitis)
• Variation of the Respiratory System includes 4 Broad Areas: 1. Anatomic Changes 2. Alveolar Gas Exchange 3. Regulation of Ventilation 4. Lung Defense Mechanisms
• Anatomic Changes - Degeneration of Intervertebral Discs - Slight Barrel Chest - Calcification of the costochondral cartilage -
• Barrel Chest is a condition in which the chest appears to be partially inflated all the time with rib cage broadened as if in the middle of a deep breathing. The person may find it hard to breathe normally.
• HYPERKYPHOSIS • is an exaggerated, forward rounding of the back. It can occur at any age but is most common in older women.
• Alveolar Gas Exchange - Loss of skeletal muscle strength in the thorax and the abdomen - Decreased elasticity of alveoli - Decreased Vital Capacity - Increased Residual Volume - Increased reliance on diaphragmatic breathing and increased work of breathing.
• Regulation Of Ventilation - The medulla is less sensitive to changes in carbon dioxide and oxygen levels. - Compromised acid-balance - Neural output to respiratory muscles decrease. - Both peripheral and central chemoreceptors are affected.
• Lung Defense Mechanism - Increase susceptibility to infection - Decreased cough reflex - Increased risk of aspiration
• Blood Pressure - Blood pressure increases as elasticity decreases in arteries with proportionately greater increase in systolic pressure, resulting in a widening of pulse pressure. - Orthostatic Hypotension
• Exercise Tolerance - The maximal heart rate with exercise is less than in a younger person. - Rise in pulse rate should be no greater than 10–20 beats/min. the pulse rate should return to the baseline rate within 2 minutes
• Arteries and Veins - No unusual sound should be heard. - SIGNS OF ARTERIAL INSUFFICIENCY: Leg pain associated with walking, burning, cramping, duskiness or mottling when the leg is in a dependent position; paleness with elevation, cool, thin, shiny skin; thickened brittle nails, diminished pulses. - Prominent, bulging veins are common, as are spider veins.
• MUSCULOSKELETAL SYSTEM • Muscle fibers reduce in number and shrink in size • Muscle tissue is replaced more slowly and lost muscle tissue is replaced with a tough, fibrous tissues. • Increase risk of loss of balance and falls • Changes in the nervous system cause muscles to have reduced tone and ability to contract. • Reduction of height
• SPECIAL ASSESSMENTS • Developmental Assessment • Cultural Assessment • Spiritual Assessment • Nutritional Assessment • Sleep Assessment • Falls Assessment • Pain Assessment • Self- Determination Assessment • Functional Assessment • Cognitive Assessment
• The MAJOR Cognitive Entities fall into Three (3) Diagnoses: DEMENTIA, DELIRIUM, DEPRESSION
• Problems with : Perception, Memory , Thinking
• Kyphosis bones become thinner and change shape