Geriatrics Assessment Shavon Dillon MD Locations for Geriatrics

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Geriatrics Assessment Shavon Dillon, MD

Geriatrics Assessment Shavon Dillon, MD

Locations for Geriatrics Assessment n Ambulatory (aka clinic visit) n Emergency room n Hospital

Locations for Geriatrics Assessment n Ambulatory (aka clinic visit) n Emergency room n Hospital n Nursing n Home home

Domains of Geriatrics Assessment n Functional status: n Activities of daily living (ADLs) n

Domains of Geriatrics Assessment n Functional status: n Activities of daily living (ADLs) n Mobility n Nutrition n Vision n Hearing n Cognitive function n Depression

Functional Status: Activities of Daily Living Basic ADLs Instrumental ADLs Bathing Using the telephone

Functional Status: Activities of Daily Living Basic ADLs Instrumental ADLs Bathing Using the telephone Dressing Transfer Toileting Grooming Feeding oneself Preparing meals Managing finances Taking medications Laundry Housekeeping Shopping Transportation

Functional Status: Mobility n Mobility: n n Testing for mobility: n n n Transfer

Functional Status: Mobility n Mobility: n n Testing for mobility: n n n Transfer Gait Balance Timed up and go test (aka Get up and go) Tandem gait Gait abnormalities: n n n Path deviation Diminished step height or length Trips Slips Near falls Difficulty turning

Nutrition n n BMI<20 Unintentional weight loss (>10 lbs or 5% of your body

Nutrition n n BMI<20 Unintentional weight loss (>10 lbs or 5% of your body weight over 6 months) n Medical illness n Depression n Dementia n Inability to shop or cook n Inability to feed oneself n Financial hardship n Ill fitting dentures n No teeth n Tooth pain n Oral candidiasis

Vision n Difficulty with driving n Read magazine n Watching television n Snellen chart

Vision n Difficulty with driving n Read magazine n Watching television n Snellen chart n Reading

Snellen chart

Snellen chart

Hearing n Bilateral n High frequency n Screening test n Whisper voice test n

Hearing n Bilateral n High frequency n Screening test n Whisper voice test n Finger rub

Cognitive function n Why is it important to assess? n n Most people with

Cognitive function n Why is it important to assess? n n Most people with dementia won’t complain of memory loss or volunteer symptoms unless asked Screening test n n n 3 word recall plus orientation Mini mental status exam (MMSE) n Score 21 -24: mild dementia n Score 10 -20: moderate dementia n Score ≤ 9: severe dementia n Score <24 warrants further evaluation n Parts of MMSE: Orientation, registration, recall, attention, language, repetition and commands

Cognitive function n n Minicog n Consist of the clock drawing test and 3

Cognitive function n n Minicog n Consist of the clock drawing test and 3 item recall n Score 0 -2: positive for dementia n Score 3 -5: negative for dementia Alternative executive function n Name as many 4 legged animals <1 minute n <8 -10 animals suggest further evaluation

Depression n PHQ 2: anhedonia sadness/depressed n PHQ 9: Mnemonic “SIGECAPS” n n n

Depression n PHQ 2: anhedonia sadness/depressed n PHQ 9: Mnemonic “SIGECAPS” n n n n Sleep Interest Guilt Energy Concentration Appetite Psychomotor agitation or retardation Suicide