Geriatric Assessment , Assessment of Elderly

Nursing Medical Surgical Topic

1. Geriatric Assessment

2. Definition Geriatrics- Geriatrics is the branch of medicine dealing with the problem of the ageing and the diseases of the elderly and management of the diseases of older adults. The branch of medicine dealing with the health and care of old people

3. Geriatric Nursing- It is the field of nursing that specializes in the care of the elderly. Gerontological nursing is the specialty of nursing pertaining to older adults.

4. Assessment of elderly The geriatric assessment is a multidimensional, multidisciplinary diagnostic instrument designed to collect data on the medical, psychosocial and functional capabilities and limitations of elderly patients.

5. Components of geriatric assessment History The Physical Examination Neuropsychiatric Examination Functional Examination

6. 1- History The geriatric assessment incorporates all aspects of a conventional medical history including demographic data, chief complaint, present illness, past and current medical problems, family and social history.

7. A) demographic Data It includes the following Full name Age, sex and birth date Marital status Source of history and reliability of historian

8. b) Chief Complaint and Present Illness Elderly patients are famous for presenting with any combination of non-specific, apparently unrelated and seemingly trivial complaints. Sometimes they have no complaint at all. Chief complains includes - Primary reason for visit, ideally in patient's own words Duration of presenting symptoms

9. c) Past Medical History This includes the assessment of the following things Previous medical history. General state of health Childhood diseases Immunizations (Tetanus-diphtheria, pertussis, measles, mumps, rubella, hepatitis A&B, influenza, varicella, h. flu., polio)

10. Chronological list of adult medical diseases, injuries Hospitalizations Allergies Medications, including dosage, duration and indication Diet

11. D) Nutritional Assessment Nutritional assessment involves the evaluation of : • Current weight in comparison to ideal body weight, with determination of BMI to evaluate for underweight or obesity. • Recent changes in body weight. • Current medications and their potential to affect the patient's nutritional status.

12. • Functional status to determine if the patient can purchase and prepare food for Himself, plus mental status with regard to their interest in food. • Food intake by food groups for a quick estimation of adequacy of diet. • Vitamin/mineral supplementation.

13. E) Social History It address familial, occupational, and recreational aspects of the patient's personal life. The components of social history are Substances (Alcohol, Tobacco, illicit drugs) occupation sexual preference Travel & transportation, exercise Living arrangements, financial security, access to medical services Recreational Activity, Sleep

14. F) Social Networks The assessment of social networks involves collecting information on (1) marital status, (2) number of children and the frequency of their visits, (3) existence and involvement of other close relatives or close friends, and (4) frequency of attendance at religious and secular meetings or events. (5)Caregivers

15. 2- Physical Examination The physical examination includes physical assessment of patient from head to toe and the systemic evaluation. It is a major tool for the diagnosis of elderly problems. It includes 1- General Appearance Apparent age, state of health, nutritional status, alertness, and evidence of discomfort. 2- Vital Signs Temperature, blood pressure, pulse rate and rhythm (regular or irregular), and respiratory rate and pattern. 3- Skin Texture, moisture and temperature; eruptions, scars, masses, telangiectasia; abnormalities of hair and nails.

16. 4- Lymph nodes Size, consistency, mobility and tenderness in occipital, cervical, post-auricular, submandibular, supra-clavicular, axillary and inguinal regions. 5- Head Size, symmetry, evidence of trauma, tenderness (including sinuses), masses, and condition of scalp. 6- Eyes Eyebrows, lids, conjunctival inflammation and scleral icterus; corneal opacities and abrasions; pupillary size, equality and reaction to light and accommodation; extraocular movements and exophthalmos; fundi for discs, vessels, macula, exudates and hemorrhages; gross visual acuity and fields. 7- Ears Auricles, auditory canals, tympanic membranes and gross hearing.

17. 8- Nose Deformities and septal deviation; obstruction, mucous membrane inflammation, polyps, bleeding and discharge. 9- Mouth Lip color, lesions and pigmentations; condition of teeth; gingival color, inflammation, and bleeding; tongue color, moisture, tremor and coating; buccal mucosa inflammation and eruptions; soft palate; odor of breath. If patient wears dentures, remove them. 10- Throat Mucosal color, exudates and lesions; tonsil size, symmetry and exudates; post-nasal discharge. 11- Neck Range of motion; pain and tenderness; tracheal position, thyroid size, symmetry and consistency; carotid impulse strength and bruits.

18. 12- Back Range of motion; pain and tenderness over spine, muscles and costovertebral angle; symmetry. 13- Thorax Shape and symmetry in excursion; intercostal retractions; rib tenderness and chest wall masses. 14- Lungs Percussion, auscultation, bronchophony , egophony , pectoriloquy and fremitus. 15- Breasts Size, shape, symmetry, tenderness and masses. 16- Heart Precordial movement, apical impulse, rate and rhythm; heart sounds, murmurs, rubs and gallops.

19. 17- Abdomen Shape, tenderness, bowel sounds and bruits; size of liver, spleen, and kidneys; masses 18- Extremities Deformities, tenderness, localized swelling, peripheral pulses and edema, cyanosis, clubbing, temperature, varicose veins, and hair loss. 19- Musculoskeletal Joint mobility, tenderness, effusion, erythema and deformity. 20- Neurologic Screening exam in non-neurologic cases, otherwise full exam. Mental status; cranial nerves; peripheral strength, tone and sensation; deep tendon reflexes; Rhomberg and gait.

20. 21- Female Pelvic and Rectal External genitalia; speculum exam for vaginal mucosa and cervix, bimanual exam for uterus, masses and tenderness; digital rectal. 22- Male Pelvic and Rectal Inguinal hernias; scrotal and testicular masses and tenderness; digital rectal, with prostate exam.

21. 3- Neuropsychiatric Examination Neurological and psychiatric examinations comprise a significant portion of the Geriatric Assessment. This is because illnesses such as dementia and delirium are common among elderly patients. It includes (Mini-Mental State Examination) Cognitive Assessment Mood Assessment Substance Abuse Competency

22. 4- Functional Assessment Functional impairment is defined as difficulty performing, or requiring the assistance of another person to perform, one or more of the following Activities of Daily Living (ADL) It includes the assessment of