Rapid Geriatric Assessment and other Tools from Saint

Rapid Geriatric Assessment and other Tools from Saint Louis University Leslie Eber MD CMD

Rapid Geriatric Assessment Ø FRAIL Screening Tool Ø SARC-F Screening Tool for Sarcopenia Ø SNAQ – Simplified Nutritional Assessment Questionnaire Ø Rapid Cognitive Screen

Saint Louis University Rapid Geriatric Assessment* * T h e r e is n o copyright o n t h e screening tools a n d t h e y m a y b e incorporated into the Electronic Health Record without permission and at n o cost. ID#: Sex: Age: Primary Care Provider Y / N Ethnicity (circle): A f r i c a n / A m A s i a n C a u c a s i a n H i s p a n i c N o n - H i s p a n i c The Simple “ F R A I L ” Questionnaire Screening Tool Fatigue: Are you fatigued? R e s i s t a n c e : C a n n o t w a l k u p o n e flight o f stairs? Aerobic: Cannot walk one block? Illnesses: D o y o u have more than 5 illnesses? L o s s of weight: H a v e y o u lost more than 5 % of your weight in the last 6 m o n t h s ? Scoring: 3 o r greater = frailty; 1 o r 2 = prefrail F r o m M o r l e y JE, Vellas B , Abellan v a n K a n G , et al. J A m M e d Dir Assoc 2013; 14: 392 -397. 5 PUBM ' 3 " * - 4 D P S F : @@@@@@ S A R C - F Screen for Sarcopenia (Loss of M u s c l e ) Component S tr e n g t h Scoring: N o n e Question H o w m u c h difficulty d o y o u h a v e in lifting a n d carrying 1 0 p o u n d s ? = 0 S o m e = 1 A lot or u n a b l e = 2 Assistance in Walking Scoring: N o n e H o w m u c h difficulty d o y o u have walking across a room? = 0 Some = 1 A lot , u s e aids or u n a b l e = 2 Rise from a Chair Scoring: N o n e H o w m u c h difficulty d o y o u have transferring f r o m a chair or bed? = 0 Some = 1 A lot or u n a b l e w i t h o u t help = 2 H o w m u c h difficulty d o y o u have Climb stairs climbing a flight of ten stairs? Scoring: N o n e = 0 Some = 1 A lot or u n a b l e = 2 H o w many times have you F a lls fallen in the last year? Scoring: N o n e = 0 1 -3 Falls = 1 4 or m o r e falls = 2 Total score of 4 or more indicates Sarcopenia F r o m M a l m s t r o m TK, Morley JE. J Frailty a n d Aging 2013; 2: 55 -6. 5 PUBM 4 " 3 $ - ' 4 D P S F : @@@@@ S N A Q (Simplified Nutritional Assessment Rapid Questionnaire) F o o d tastes a. very bad b. bad c. average d. good e. very good M y appetite is very poor average good very good a. b. c. d. e. W h e n Normally I eat Cognitive Screen (RCS) 1. Please r e m b e r these five objects. I will a s k y o u w h a t they are later. [ R e a d each object to patient using approx. 1 second intervals. ] Apple Pen Tie House Car 2. [Give patient pencil a n d the blank sheet with clock face. ] This is a clock face. Please put in the hour m a r k e r s a n d the time at ten minutes to eleven o’clock. [2 pts/hr markers ok; 2 pts/time correct] a. I feel full after e a t i n g only a few mouthfuls a. Less than one meal a day . W h a t were the five objects I asked y o u to r e m b e r ? [1 pt/ea] b. I feel full after e a t i n g about a third of a meal b. One meal a day . I ’ m g o i n g t o tell y o u a story. P l e a s e listen carefully b e c a u s e a f t e r w a r d s , I ’ m g o i n g t o a s k y o u a b o u t it. c. I feel full after e a t i n g over half a meal c. Two meals a day d. I feel full after e a t i n g m o s t of the m e a l d. Three meals a day I h a r d l y ever feel full e. M o r e than three meals a day e. Scoring: a=1, b=2, c=3, d=4, e=5. A score < 1 4 indicates significant risk of at least 5 % weight loss within 6 months. F r o m W i l s o n et al. A m J Clin N u t r 2 0 0 5 ; 8 2 : 1 0 7 4 - 8 1. 5 PUBM 4 / " 2 4 D P S F : @@@@@ Jill w a s a very successful stockbroker. S h e m a d e a lot of m o n e y o n t h e s tock m a r k e t. S h e t h e n m e t J a c k , a d e v a s t a t i n g l y h a n d s o m e m a n. S h e married h i m a n d had three children. They lived in Chicago. She then stopped w o r k a n d s t a y e d at h o m e t o b r i n g u p h e r children. W h e n t h e y w e r e teenagers, she went b a c k to work. S h e a n d Jack lived happily ever after. W h a t state did she live in? [1 pt] SCORING 8 -10……. . . 6 -7… … …. 0 -5… … …. Normal Mild Cognitive Impairment Dementia F r o m M a l m s t r o m T K , V o s s V B , Cruz-Oliver D M et al J Nutr Health Aging 2015; 19: 741 -744. 5 PUBM 3 $ 4 4 D P S F : @@@@@ Advance Directive D o you have an advance directive? Y / N Are you lonely? Y / N 3 FWJTFE 8 / 2 7 / 2 0 1 9

Frailty – Why does it matter Frailty is a medical syndrome marked by reduced physiologic function, which increases the risk of vulnerability and shortterm mortality, particularly in the face of a stressor. Frailty has been shown to predict poor outcomes including falls, disability, major morbidity following surgery, and mortality among older adults Translating Frailty Research Into Clinical Practice: Insights From the Successful Aging and Frailty Evaluation Clinic: M. Huisingh-Scheetz et al. / JAMDA 20 (2019) 672 e 678

Frailty – Why does it matter Ø Frailty as accumulation of deficits: “the more things that are wrong, the more likely that person is frail” (Rockwood 2007) Ø Frailty as a biologic syndrome of decreased reserve resulting from cumulative declines across multiple physiologic systems (Fried et al. 2001)

Frailty – Why does it matter Ø It is estimated about 10% of older Adults are Frail Ø Frailty is also associated with other adverse outcomes including geriatric syndromes (falls, delirium, immobility, incontinence, dementia), poor surgical outcomes, hospitalization and death Ø There are many tools to assess Frailty

The Simple FRAIL Questionnaire Screening Tool Fatigue: Are you fatigued? Resistance: Cannot walk up one flight of stairs? Aerobic: Cannot walk one block? Illness: Do you have more then 5 illnesses? Loss of Weight: Have you lost more than 5% of your weight in the last 6 months? Scoring: 3 or greater- Frailty 1 -2 - Prefrail

FRAIL-NH Tool

Sarcopenia Ø The loss of muscle mass, muscle strength and physical function Ø Associated with adverse outcomes such as falls, functional disability, poor quality of life and increased risk of death Ø Is an independent risk factor falls, fractures and mortality Ø Highly prevalent in older nursing home residents (over 40%) Ø Malnutrition may be an independent risk factor Prevalence and Associated Factors of Sarcopenia in Nursing Home Residents: A Systematic Review and Meta-analysis: Y. Shen et al. / JAMDA 20 (2019) 5 -13

SARC-F Screening Tool for Sarcopenia score of 4 or more = Sarcopenia

SNAQ – Simplified Nutritional Assessment Questionnaire My appetite is a. Very poor b. Poor c. Average d. Good e. Very good When I eat, I feel full after a. Eating only a few mouthfuls b. Eating about a third of a plateful c. Eating over half a plateful d. Eating most of the food e. Hardly ever

SNAQ – Simplified Nutritional Assessment Questionnaire Food tastes a. Very bad b. Bad c. Average d. Good e. Very good Normally I eat a. Less than one full meal a day b. One meal a day c. Two meals a day d. Three meals a day e. More than three meals a day, including snacks

SNAQ – Simplified Nutritional Assessment Questionnaire Scoring: a=1 b=2 c=3 d=4 e=5 A score of <14 - indicates significant risk of at least 5% weight loss within the next 6 months

Rapid Cognitive Screen 1. Please remember these five objects. I will ask you what they are later. [Read each object to patient using approx. 1 second intervals. ] Apple Pen Tie House Car 2. [Give patient pencil and the blank sheet with clock face. ] This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock. [2 pts/hr markers ok; 2 pts/time correct] 3. What were the five objects I asked you to remember? [1 pt/ea] 4. I’m going to tell you a story. Please listen carefully because afterwards, I’m going to ask you about it. Scoring: 8 -10: Normal 6 -7: Mild Cognitive Impairment 0 -5: Dementia

Rapid Geriatric Assessment See it on You. Tube at https: //youtu. be/z 79 -UQv. TOXs Less then 5 minutes to complete

Treatable Causes of Dementia Drugs Emotional (Depression) Metabolic (TSH) Eyes and Ears NPH Tumors Infection Anemia (B 12) Sleep Apnea

Weight Loss: Meals on Wheels Medications producing anorexia Emotional –Depression Abuse: elderly alcoholism Late life paranioa Swallowing problems Oral problems Nosocomial infections Wandering and other dementia related problems Hypothyroidism, hypercalcemia, hyperglycemia, Hypoadrenalism Enteral problems: celiac disease Low salt, sugar, cholesterol diets Stones - cholecystitis

Fatigue Depression Sleep Apnea Hypothyroidism Vitamin B 12 Anemia Hypotension