Rapid Geriatric Assessment and other Tools from Saint

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

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

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

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

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

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

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

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

FRAIL-NH Tool

Sarcopenia Ø The loss of muscle mass, muscle strength and physical function Ø Associated

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

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

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.

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

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

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.

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

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

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

Fatigue Depression Sleep Apnea Hypothyroidism Vitamin B 12 Anemia Hypotension