Comprehensive Geriatric Assesment

Dr. Kaushik Ranjan Das

Presenting complaints :

H/O Present illness :

H/O Past illness

Personal history:

Family history :

Occupational history:

Socio-economic history : Living pattern & arrangement –

Financial aspect :

Support system in family & society :

Means of recreation, Values , Preferences :

History of Medication : Names & doses of drugs

Any drug allergy :

Physical Examination :General & systemic examination.

Functional assessment :

ADL (Katz index ,downloadable) :It has six item questionnaire,score of 1 for independent & score of 0 for dependence, score of 06 means patient independent and score of 0 means patient is very dependent.

Kartz Index of ADL

1. Scoring : Score of 06 , high ,patient is independent ; Score of 0, low patient is very dependent . www.aafp.org> The geriatric assessment- American family physician.

IADL(Lawton IADL scale, downloadable): It has 09(nine) item questionnaire. scoring is done, high score for independence. Score have meaning for a particular patient only . Declining score reveal deterioration.

Lawton Instrumental Activities of Daily Living Scale (Self-Rated Version)

For each question, circle the points for the answer that best applies to your situation

N.B . Scores have meaning for a particular patient only . Declining score reveal deterioration

Nutritional assessment: It is done with 11 item check list . Scoring is done, negative answer means normalcy. So, score 0-2 means good nutrition;3-5 moderate risk; 6&more- high nutritional risk.

Nutritional Assessment Check List

Scoring ; 0—2 good nutrition ; 3—5 moderate risk; 6 & more high nutritional risk .

(American Family Physician)

Vision: By asking about viewing TV, reading news paper,snellen’s chart/jaeger’s card /E chart etc.

Hearing :Whisper test –sitting 1-2 feet behind the patient, ear opposite the examining ear plugged, 02 syllable word whispered ,ask to repeat, if cannot then clearly impaired; similarly in other ear.

Gait &Balance :Timed get up & go test –patient with or without shoes, sits on a armless chair, stands up walks 10 ft, moves around & comes back & sits again . If the task is completed in <10 sec – freely mobile; 10-20 secs mostly independent;20-29 secs-variable mobility;>30secs assisted mobility.

Other tests for Gait & Balance : Tinetti gait & balance test & Morse fall risk

Six minute walk test : Patients may be asked to do it at their home and visit the Geriatric clinic with report (i.e. distance walked in six minutes): It is used to assess aerobic capacity & endurance and done for cardiopulmonary issues and other conditions as well.

Distance of 400 to 700metres covered in six minutes is considered as normal.

Cognitive function:

MINICOG :Components are (1)03 object registration-say 03 words ( river, nation, finger) & ask to repeat & remember (2) Clock face drawing – ask to draw a clock face (preprinted circle may be supplied), put all numbers then set hands at 10 past 11 . move to step 03 if cannot do in 03 minutes.(3) Ask to recall 3 words spoken earlier.

Score : Word recall:0-3 ; Clock draw:0-2, normal-2 inability -0

Cut off point of<3has been validated &<4 has been recommended for further evaluation of cognitive status. If so positive do MMSE.

MMSE: By using MMSE standardized proforma .Scoring is done score<24 is cutoff point

Animal Naming: Who cannot do MMSE. Ask to name animal in 60secs.Average performance is 18/min.,<12 is abnormal

For people unable to do MMSE :

Animal naming test :

Naming animals in 60 sec.

Average performance = 18/ min.

> 12 /min = abnormal

Depression :

Geriatric depression scale (long)

Geriatric depression scale (short ) : it is also validated for screening depression in elderly.

Geriatric Depression Scale (Short form)

Choose the best answer for how you have felt over the past week.

Answers in BOLD indicates depression.

Score 1 point for each bolded answer .

Score > 5 suggestive of depression ;

Score>/= 10 points is always indicative of depression ;

Score > 5 points should always warrant a follow up comprehensive assessment

Medication review : ( Comorbidity Polypharmacy score-CPS) ;

CPS provides 1 point to each pre-hospital medication & each pre-hospital morbidity. Score0-7 is mild ,8-14 moderate,15-27 severe & morbid if >/=22.

SARCOPENIA ( SARC-F ): STRENGTH, AMBULATION, RISING FROM A CHAIR, STAIR CLIMBING AND HISTORY OF FALLING

QUESTIONNAIRE

NAME:

DATE:

TOTAL SCORE -         (SCORING: A score of 0-3 = low risk of sarcopenia A score ≥ 4 = at risk of sarcopenia .)

AUTHOR: Malmstrom TK, Morley JE. Sarcopenia: the target population. J Frailty Aging 2013; 2: 55–56

***There are other component also Viz. Osteoporosis, elder’s abuse, urinary incontinence, cancer screening, those may be taken into account.