The geriatric evaluation is a multidimensional, multidisciplinary diagnostic instrument designed to gather information on the medical, psychosocial and functional capabilities and constraints of elderly patients. Various geriatric practitioners use the information created to establish treatment and long-lasting follow-up strategies, organize for medical care and corrective services, organize and help with the detailed procedure of case management, figure out long-lasting care requirements and optimum placement, and make the very best use of health care resources.
The geriatric assessment differs from a basic medical evaluation in 3 basic ways:
Whereas the standard medical evaluation works reasonably well in most other populations, it tends to miss some of the most prevalent issues faced by the older patient. These obstacles, frequently referred to as the “Five I’s of Geriatrics”, include intellectual disability, immobility, instability, incontinence and iatrogenic disorders. The geriatric assessment effectively addresses these and numerous other areas of geriatric care that are important to the successful treatment and avoidance of illness and special needs in older people.
Carrying out a comprehensive assessment is an ambitious undertaking. Below is a list of the locations geriatric suppliers might select to evaluate:
The primary care physician or community health worker usually initiates an assessment when he or she detects a potential problem. Like any effective medical evaluation, the geriatric assessment needs to be sufficiently flexible in scope and adaptable in content to serve a wide range of patients. A complete geriatric assessment, performed by multiple personnel over many encounters, is best suited for elders with multiple medical problems and significant functional limitations.
Ideally, under these circumstances, an interdisciplinary team — representing medicine, psychiatry, social work, nutrition, physical and occupational therapy and others — performs a detailed assessment, analyzes the information, devises an intervention strategy, initiates treatment, and follows-up on the patient’s progress. Due to the intricate nature of comprehensive assessments, many teams designate a case-manager or caseworker to coordinate the entire effort.
Most assessments take place in medical offices and inpatient units over multiple visits. If at all possible, however, at least one member of the team (rarely the physician) will attempt to visit the patient at home. Despite the problem of low or no reimbursement, the typically high-yield of information from even a single home visit makes it an extremely efficient use of resources.
Most geriatric assessments, performed under the constraints of time and money, tend to be less comprehensive and more directed. Although such modifications are best suited to relatively high-functioning elders living in the community, many practitioners find some version of a directed geriatric assessment to be a more realistic tool in a busy practice. Patient-driven assessment instruments are also popular among geriatricians. Asking patients to complete questionnaires and perform specific tasks not only saves time, but also it provides useful insight into their motivation and cognitive ability. To the extent that patients are unable to complete the assessment themselves, practitioners resort to traditional patient interview techniques that frequently involve input from a family member or other caregiver.
During your upcoming site visits, you will perform a directed geriatric assessment (DGA), ideally with the same patient, over two sessions. In the interest of education, most of your DGA instruments are student-driven, rather than patient-driven, and require relatively little information from caregivers who may or may not be available at the time of your visit. We have divided the DGA in two parts, each with three subsections. In Part I, you will perform an expanded medical interview covering the clinical history, nutritional assessment and a social evaluation. In Part II, you will perform neuropsychiatric, physical and functional examinations.
What follows is a reproduction of the History and Physical (H&P) format that you will use in your Physical Diagnosis II course next semester. Although all geriatric practitioners do not use a standard assessment format (comprehensive or otherwise), most agree on basic content. The comprehensive geriatric assessment (history & examination) following the Physical Diagnosis outline covers the most significant content areas of a prototypical geriatric assessment. As you can see, it moves well beyond the standard H&P, which is precisely the point. We have designed it to correlate as closely as possible with the history and physical you will be learning later this year. It is to your considerable advantage to review this information before meeting your patients face-to-face on the site visits. The DGA instrument you will use during your encounter immediately follows this section.
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