Transcript GERIATRIC FUNCTIONAL ASSESSMENT

GERIATRIC FUNCTIONAL
ASSESSMENT
• Doç. Dr. Nurver Turfaner
• Department Of Family
Medicine
Activities of daily living( ADL)
• Basic ADLs:
Mobility,bathing,dressing,grooming,
transferring, toileting,continence,eating
• Instrumental ADLs:Using telephone,
driving, using public transportation,
shopping, preparing meals,
housework,taking medicine, managing
money
Ability: Physical assessment
6 maneuvers task ( function tested )
• 1. Both hands behind head ( hair
combing, washing back, etc)
• 2.Both hands together in back of waist
( lower extremity dressing, hygiene)
• 3.Sitting, touch great toe with opposite
hand (lower extremity dressing,
hygiene)
Ability: Physical assessment
• 4.Squeeze examiner’s two fingers with
each hand (opening jars, doors, etc)
• 5.Hold paper between thumb and lateral
side of index finger while examiner
tries to pull out ( picking up objects)
• 6. Stand from chair with hands crossed
over chest (transferability)
Ability: Cognitive assessment
• Mini-mental state
• Orientation:What is the
(year)(season)(date)(day)(month) 5
• Where are
we?(state)(city)(town)(hospital)(floor) 5
• Registration:Name 3 unrelated objects. Ask
for all 3. Repeat until patient learns all 3.
Record number of trials
• Attention and calculation: Serial 7’s
(93,86,79,72,65).Stop after 5. OR spell
WORLD backwars. D L R O W 5
• Recall: Ask 3 subjects above 3
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Language:
Naming: pencil and watch 2
Repetition: No ifs, ands or buts 1
3-stage command: Take paper in your
right hand, fold it in half,and put it on
the floor 3
• Reading: Close your eyes. 1
• Writing: Write a sentence. 1
• Copying: Intersecting pentagons 1
• Scoring ≤ 20 = dementia
Motivation: Assess depression-Single
question:’’Do you often feel sad or depressed’’
• Short geriatric depression scale
Choose the best answer for how you felt
over past week ( Yes or No )
• 1.Are you basically satisfied with your
life Y
• 2.Have you dropped many of your
activities or interests N
• 3.Do you feel your life is empty N
• 4.Do you often get bored N
• 5.Are you in good spirits most of the
time Y
Motivation: Assess depression-Single
question:’’Do you often feel sad or depressed’’
• 6.Are you afraid that something bad is
going to happen to you N
• 7.Do you feel happy most of the time Y
• 8.Do you often feel helpless N
• 9.Do you prefer to stay home rather
than going out and doing new things N
• 10.Do you feel you have more problems
with memory than most N
Motivation: Assess depression-Single
question:’’Do you often feel sad or depressed’’
• 11.Do you think it is wonderful to be
alive Y
• 12.Do you feel pretty worthless the way
you are now N
• 13.Do you feel full of energy Y
• 14.Do you feel your situation is hopeless
N
• 15.Do you think most people are better
off than you N
• ‘’ Normal’’ answers indicated in bold (Y
/ N)- › 5 ‘’ Depressed’’ answers=
positive screen
FALLS
• KEY POINTS
• Falls are common in the elderly and
can result in serious, even fatal,
injury.
• Most falls are multifactorial in
nature.
• Physicians should ask about falls
periodically, because many elders
consider falling normal and may not
report it.
FALLS
• Falling is preventible, and there are well
recognized risk factors.
• A thorough evalution of falls, targeted
treatment, and management of risk
factors can reduce the risk of future
falls.
• Physical restraints are not necessary to
reduce the risk of future falls. They are
likely to increase the risk of injury and
should be avoided.
FALLS
• In a patient who falls, sedating
medications should be minimized or
eliminated.
• All patients who fall but who are able to
participate in an exercise program
should pursue a program of balance
training and strengthening.
Initial Evaluation of Falls
• History
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Circumstances of fall
Vision or hearing deficits
Medical conditions
Medications( especially sedatives,
psycotropics, antihypertansives, narcotics,
anticonvulsants)
• Functional abilities
Initial Evaluation of Falls
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Physical examination
Postural blood pressure
Heart rhythm
‘’ Get up and go’’ test
Visual acuity
Targeted neurologic examination
Targeted musculoskelatal examination
Hemodynamic response to carotid sinus
massage ( in appropriate patients)
Initial Evaluation of Falls
• Diagnostic Studies
• None required routinely
• If indicated in the appropriate
patient: complete blood count,
blood urea nitrogen (BUN) level,
creatinine, electrolytes, glucose,
thyroid function, vit. B12, Holter
monitor
Risk Factors for Falls in Older
People
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Age-related changes in
Vision
Hearing
Proprioception
Muscle activation (delayed onset of
compensatory activation in response
to postural changes)
• Blood pressure (reduced
compensatory response to postural
changes)
Risk Factors for Falls in Older
People
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Age › 80 years
Cognitive impairment
Depression
Functional impairment (measured by
changes in activities of daily living)
• Visual impairment
• History of falls
• Gait or balance deficit
Risk Factors for Falls in Older
People
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Use of assistive device
Arthritis
Leg weakness
Orthostatic hypotension
Psychotropic or sedative drug use
Female gender
Frequent fear of falling
Urinary Incontinence
• In the elderly, urinary incontinence affects
up to 30% of women and up to 15% of men.
• Maintaining continence requires more than
intact urinary function; it also requires
mobility, motivation, proper access to
facilities and relatively intact function.
• Acute changes in continence are often caused
by underlying medical conditions (e.g,
infection, hypoglycemia), and the incontinence
may be reversible
• Men are more likely to have overflow
and urge incontinence. Women are
more likely to have urge and stress
incontinence.
• History, examination, urinalysis, and
post-void residual bladder volumes
usually lead to the proper
categorization of incontinence, with no
further testing needed.
• Kegel exercises, bladder training
exercises, and use of an incontinence
diary are effective for managing urge
Urinary Incontinence
• Stress incontinence is poorly treated
with drug therapy but successfully
treated with surgery; urge incontinence
is poorly treated with surgery but
successfully treated with drugs.
• Drugs used to treat urge incontinence
are all anti-cholinergics, and sideeffects may limit their use in the
elderly.
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Urinary Incontinence
• Functional incontinence is common in
frail or demented elders and is treated
with environmental adjustments and
with scheduled and prompted voiding.
. Incontinence and asymptomatic
bacteriuria may coexist in nursing home
patients, but incontinence does not
improve with eradication of bacteria.
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RATIONAL DRUG PRESCRIBING
KEY POINTS
Certain medications should be avoided
in the elderly.
Age alone should not be a criterion for
avoiding the use of drugs with
appropriate indications (e.g.,β-blocker
after myocardial infarction)
A certain degree of polypharmacy (use
of numerous drugs) may unavoidable in
the elderly, but each drug should be
associated with an appropriate
indication
RATIONAL DRUG
PRESCRIBING
• Avoid using one drug to treat the
adverse effect of another.
• The effects and toxicities of some
drugs change with aging, resulting in
more narrow indices.
• Renal function declines with aging and
has an impact on the dosing of many
drugs, whereas liver function generally
does not.
• DIKKATINIZ ICIN TESEKKUR
EDERIM