Geriatrics

more disease, functional dependence

inpatient and outpatient geriatric assessment signficantly reduces functional decline and improve mental health with no increase in costs

beenfits families too risk to patients:
 * increasing age...
 * pre-admission disability in independdnt activities of daily living
 * lower cognitive status

by age 85, 30% of patients have significant dementia

aim in outcomes:\
 * improve acitivty level, diagnosct accuracy, living situation
 * reduceplypharmacy, precribe appropriate medications
 * decrease hospitalizeiotns, nursing homes
 * increase home health care
 * reduce medical costs
 * prolong survival
 * prolong quality of life

doumen: Aiiies of daily living need help...How do you...
 * ADLs...things have to do self
 * IADLs...driving, etc
 * Vision, Hearing
 * Assess Cognition
 * ini-mental status exam
 * mobility: strengrh, gait
 * Affect(Mood)
 * Depression very common....1%...
 * 7-8% of older adults are depressed
 * as high as 30%in nursing facilities
 * Nutrition

all things can learn quickly; helpful

ADLs... Bathing Dressing Toileting Continence Transferring Feeding If can't do these, can't be left alone Every week have geriatrics... Have to be preparedto do Do you need another person to help? Device (Wheelchair, walker oay) ask if it is safe Rates as: Independent (or device-assisted) Dependent Bathing usaully first to go

last thing to go is usually feeding IADLs These tasks may be delegated
 * using telephone
 * travelransportaion
 * shopping
 * preparing meals
 * housework
 * taking medication
 * managing money

18% of pts over 75, 40% of pts over 85 hae cognitive impairments MMSE Orientation date, place registration: immediate repetition Serial 7's (Or WORLD Backwards) recall 3 itmes after 1 minute language: naming, repeatng, writing 3 step ommand read and perform task;copy interecting pentagons

if miss 3 item recall...probably have early alzheimer's

Next week: registration: 3 oobjects distractor: draw hand and numbers at 8:20 or 11:20 recall of 3 objects at 1 minute score 3/3 is 99% specific to exclude cognitive impairment

use 1 or two syllable words...objects not in room warn going to ask to repeat them back

if remember 2, and clock okay: borderline normal 2, and clock not okay: abnormal

Screening for depression may present as anxity, anhedonia 2 question depression screen in clincal guidelines as screen of choice in primary care settngs Geriatirc depression scale...15 activities Two question depression screen: During the past month, have you often been bothered by feeling down, depressed, or hopeless: During the past month, have yuo often be bothered by little interest ro pleasure in doing things? if asked exactly as above: "No" to both: 99% specific to exlclude depression if say no fairly quickly if say 'yes' then positive if equivocates...usually a yes

geriatric depression scale: if > 5 positive, significant predictor for depression treat immediately

Nutrition DETERMINE the risk: D: Disease, acute and chronic E: Eating poorly T: Teeth prob lems E: Economic hardship R: Reduced social contact M: Medications I: Involuntary weight loss N: needs ADL or IADL assistence E: Elderly

weight loss is indicatorfor cancer screen weight loss creen

"did ou fall during the past year? Did you fracure anything?

Mobility: ask about falls Validated test: TimedUp and Go: TUG: A quick screen Sit in chair walk 10 feet in straight line from chair as quickly as feel comfortable get used to walking with patient

if 12 seconds or less...probably not impaired if > 15 s, abnormal. Send for more detailed assessment

more detailed: Tinetti Gait and Balance Assessment detailed assesment of gait and balance...10_ mnutes Low score is bad

Driving... Did you ever drive moblity mpaired cognition imparied any accidens any near misses do others yell at you do family mebers refuse to let you drive them?

FLorida... 9% are licensed drivers... 20% have dementia second highest accident rate behind 19 year olds

stop going on highway, unfamiliar places... drivability program