Geriatric Assessment

Submitted by: PGI ANGELO D. VILLAROMAN

I. Patient Information
Arthur Y. Villaroman, 68-year old male, catholic, past US immigrant, currently living in
Licab, Nueva Ecija. He was an ischemic stroke survivor (2016) and is currently on maintenance
medications. He has hemiplegia as of the present. He usually visits his neurologist in Quezon
City regularly every 3 months. However, due to the pandemic, he stopped his regular check-ups.
Last visit was March 2020. This geriatric assessment was done in person last January 27-29,
2022.

II. Past Medical History

● Hypertension Stage II, controlled – highest BP 190/100 mmHg, usual BP 130-140/90
mmHg – diagnosed 2005, currently maintained on Telmisartan 80mg OD, Clonidine
150mg TID, Amlodipine 5mg OD, metoprolol 50mg BID
● Dyslipidemia (2005), controlled - currently maintained on atorvastatin 40mg OD
● Stroke (2016) - ischemic - on secondary stroke prevention -on clopidogrel 75mg OD
● No Previous Surgeries
● Vaccinations
o Childhood vaccinations – unrecalled
 o Influenza vaccine, last updated dose (2015)
o COVID-19 (Pfizer) 2 doses completed (October- November, 2021)
● Most Recent Laboratories
o Unable to find

III. Family History

● Hypertension – mother, siblings, sons, daughters
● Stroke- mother, brother
● Diabetes mellitus – sister
● Breast Cancer - sister

IV. Family Genogram

Arthur is the fourth-born child of the Villaromans from Licab, Nueva Ecija. Both of his
parents died of old age but with known systemic diseases like hypertension (both parents) and
stroke (mother). He has 4 other siblings; all are still alive. Growing up, Arthur lived in a post-war
era wherein his father was the former mayor of the town during the Japanese occupation. Hence,
the parenting style he grew up with is of military/authoritarian type.
Arthur married Nancy at a young age of 19 and had 3 children (2 daughters 1 son).
Undergraduate of engineering (4th year), Arthur opted to become a businessman and became
successful at multiple businesses (mainly agricultural and construction needs). He was able to
provide for all the financial needs of his family. All of his children are college graduates and
professionals in their fields.
Arthur also had children with Grace, 1 son and 1 daughter, both graduates of medical
related fields. Having a second family, he decided to go to the US to have more opportunities for
financial provision. He returns to the Philippines twice a year ever since the year 2000. Ever
since then up to the current time, he was living in this family. All of his children are also in good
relationships.
Last 2016, Arthur suffered from a stroke and never returned to the US again. Currently,
he is being taken care of Grace and their children in their home. Due to incapacitation brought by
the CVA, the primary decision maker for finances and home maintenance is Grace. However,
Grace still maintains a well-balanced environment by always asking for opinions from Arthur
and their children.
V. Family Profile
● Type of Family: Nuclear Family
● Stage in Family Life Cycle: Family in the Later Years
● Socio-economic Status: Lower middle income class
● Family Set-up: Democratic
● No. of household members: 5
● Family Illness Trajectory: Stage V: Adjustment to permanency of the outcome (because
of his stroke)

VI. Family APGAR Part I

SOME OF HARDLY
ALMOST
THE TIME EVER
ALWAYS
QUESTIONNAIRE PAMINSAN HALOS
PALAGI
-MINSAN HINDI
(2)
(1) (0)
I am satisfied that I can turn to my family
for help when something is troubling me
(ADAPTATION)
A ✔
Ako’y nasisiyahan dahil nakakaasa ako ng
tulong sa aking pamilya sa oras ng
problema
I am satisfied with the way my family talks
on things with me and shares problems with
me
P (PARTNERSHIP) ✔
Ako’y nasisisyahan sa paraang
nakikipagtalakayan sa akin ang aking
pamilya tungkol sa aking problema
I am satisfied that my family accepts and
supports my wishes to take on new
activities or directions
(GROWTH)
G ✔
Ako’y nasisiyahan at ang aking pamilya ay
tinatanggap at sinusuportahan ang aking
mga nais na gawin patungo sa mga bagong
landas para sa aking pag-unlad
I am satisfied with the way my family
expresses affection and responds to emotion
such as anger, sorrow, and love
(AFFECTION)
A Ako’y nasisiyahan sa paraang ipinadadama ✔
ng aking pamilya ang kanilang
pagmamamhal at nauunawaan ang aking
damdamin tulad ng galit, lungkot at
pag-ibig
 I am satisfied with the way my family and I
share thought together
R (RESOLVE) ✔
Ako’y nasisiyahan na ang aking pamilya at
ako ay nagkakaroon ng panahon sa isa’t isa

Score Interpretation
1-3 Severely dysfunctional
4-7 Moderately dysfunctional
8-10 Highly functional

Total Score: 7 – Moderately dysfunctional

Arthur is satisfied with the way he can always ask for help or favor from his family
whenever he has problems. He is also somewhat contented on how they can talk these problems
out. Although, he has mentioned that he is saddened whenever he thinks about his children in his
first family for they occasionally call or chat with him. He is also somewhat glad about how his
family accepts and supports his visions and goals in life. He is also very happy with how the
family expresses their love for the padre de familia. Lastly, he is sometimes happy but also sad
with how the family no longer connects and shares thoughts together as compared before. He
mentioned that his children, as young adults, are most of the time not able to come back home
(busy with business and medicine training) and that makes him sad. Arthur’s family is
moderately dysfunctional as of the moment.

VII. Family APGAR Part II

WHO LIVES IN YOUR HOME? HOW DO YOU GET ALONG?
Sino-sino ang nakatira sa inyong tahanan? Paano ang inyong relasyon?
Fairly
Poor
Name Relationship Age Sex Well (Hindi
(Hindi
(Pangalan) (Relasyon) (Edad) (Kasarian) (Mabuti) gaanong
mabuti)
mabuti)
Grace Dela Cruz Wife 50 F ✔
Angelo Villaroman Son 25 M ✔
Monina Villaroman Daughter 23 F ✔
Jaypee Bauson None 25 M ✔

IF YOU DON’T LIVE WITH YOUR FAMILY, LIST

THE PERSONS TO WHOM YOU TURN FOR
HOW DO YOU GET ALONG?
HELP
Paano ang inyong relasyon?
Kung hindi ka nakatira sa bahay kasama ang iyong
pamilya, kani-kanino ka humihingi ng tulong?
Poor
Name Relationship Age Sex Well
Fairly (Hindi
(Pangalan) (Relasyon) (Edad) (Kasarian) (Mabuti)
mabuti)
 (Hindi
gaanong
Mabuti)
Noel Villaroman Son 44 M ✔
Gerry Domingo Bestfriend 62 M ✔
Willie Domingo Bestfriend 66 M ✔
Alex Ramos Family friend 68 M ✔

Arthur gets along very well with everyone in his current residence. If he has a problem or
feels not okay, he always has someone to go to, may it be family members or friends.

VIII. SCREEM Family Resource Survey (SCREEM-RES)

Strongly
Strongly
Disagree Disagree
Agree Agree
Questionnaire Hindi Lubos na
Lubos na Sumasang-a
Mga Tanong sumasang-a hindi
sumasang yon (2)
yon (1) sumasang-ay
-ayon (3)
on (0)
We help each other in our family
Ang bawat isa ay nagtutulungan ✔
sa aming pamilya
Our friends and people in our
S community are helpful to our
family
✔
Natutulungan kami ng aming
mga kaibigan at kasamahan sa
komunidad
Our culture gives our family
strength and courage
Ang aming kultura ay ✔
nagpapapanatag ng loob ng
aming pamilya
Our culture of helpfulness,
C caring, and concern in our
community is helpful to our
family
✔
Ang kultura ng pagtutulungan at
pagmamalasakit sa aming
komunidad ay nakakatulong sa
aming pamilya
Our faith and religion are helpful
R ✔
to our family
 Ang aming pananampalataya at
relihyon ay nakakatulong sa
aming pamilya
Members of our church and/or
religious groups are helpful to
our family
✔
Natutulungan kami ng aming
mga kasamahan o mga grupong
relihyoso
Our family’s savings are
sufficient for our needs
Sapat ang naipong pera ng ✔
aming pamilya para sa aming
mga pangagailangan
E
Our family’s income is sufficient
for us for our needs
Sapat ang kinikita ng aming ✔
pamilya para sa aming
pangangailangan
Our knowledge and education is
sufficient for us to understand
the information about the illness
Sapat ang aming ✔
edukasyon/kaalaman upang
maintindihan ang mga
E impormasyon tungkol sa sakit
Our knowledge and education is
sufficient for us to take care of
our sick family members
✔
Sapat ang aming
edukasyon/kaalaman upang
maalagaan ang sakit
Medical help is readily available
in our community
✔
Madaling makakuha ng tulong
medical sa aming komunidad
M Doctors, nurses, and/or health
workers in our community are
helpful to our family ✔
Natutulungan kami ng mga
doktor, nars at health workers

Score Interpretation
0-12 Severely inadequate resources
 13-24 Moderately inadequate family resources
25-36 Adequate family resources

Total Score: 34 – Adequate family resources

Arthur has been a very friendly person ever since he was a child. He is known for being a
“pala kaibigan, mabarkada, pang-masa” kind of person in his town. Being popular in their
place, he has gained a lot of friends; some of which became life-long. Hence, in terms of social
resources, he always has a family or a friend to turn to. With regards to culture, Arthur always
believes in good camaraderie or “Pakisama” as he mentioned, “kapag maganda ang pakisama,
laging maganda ang balik”. Arthur is also a Roman Catholic although he is not attending masses
anymore. He likes to listen to religious radio programs every night. He also prays everyday and
mentioned that he trusts in the Lord. Economically, he still provides for the family since he
receives his monthly pension and still earns from all the farmlands he has. In terms of being
educated, Arthur is a very smart person even though he did not finish his engineering degree. He
always loves to read and learn new things. Hence, whenever his doctor is explaining his
condition, he tries to understand it the best way he could either by asking his children in the
medical field, or read it himself. In terms of medical needs, he always trust in his current wife
and his children for his needs. Arthur’s family has adequate resources based on the
SCREEM Family Resource Survey.

IX. Katz Index of Independence in Activities of Daily Living

Activities Independence (1 point) Dependence (0 points)
Points (1 or 0) NO supervision, direction, or WITH supervision, direction,
personal assistance personal assistance, or total care
BATHING (1 POINT) Bathes self completely (0 POINTS) Need help with
or needs help in bathing only a bathing more than one part of the
Points: 0 single part of the body such as the body, getting in or out of the tub
back, genital area or disable or shower. Requires total bathing
extremity
DRESSING (1 POINT) Gets clothes from (0 POINTS) Needs help with
closets and drawers and puts on dressing self or needs to be
Points: 0 clothes and outer garments complete completely dressed.
with fasteners. May have help tying
shoes.
TOILETING (1 POINT) Goes to toilet, gets on (0 POINTS) Needs helps
and off, arranges clothes, cleans transferring to the toilet, cleaning
Points: 1 genital area without help. self or uses bedpan or commode.
TRANSFERRIN (1 POINT) Moves in and out of bed (0 POINTS) Needs help in
G or chair unassisted. Mechanical moving from bed to chair or
transfer aids are acceptable. requires a complete transfer.
Points: 1
CONTINENCE (1 POINT) Exercises complete (0 POINTS) Is partially or
self-control over urination and totally incontinent of bowel or
Points: 1 defecation. bladder
FEEDING (1 POINT) Gets food from plate (0 POINTS) Needs partial or
into mouth without help. Preparation total help with feeding or
Points: 1 of food may be done by another requires parenteral feeding.
person.

Total Score: 4 - moderate impairment

After Arthur’s stroke in 2016, he cannot do most of the tasks he was able to do before.
Bathing cannot be done alone due to the risk of having a fall/slip. In terms of dressing, he needs
assistance since he cannot stand on one foot being hemiplegic. However, he can still use the
toilet alone. Also, he has no problem in terms of transferring from bed or chair. Most of the time
he uses a cane to assist his walking. Lastly, he can also feed on his own. On the Katz Index of
independence in ADLs, he is classified to have moderate impairment.

X. Lawton-Brody Instrumental Activities of Daily Living Scale

Scoring: For each category, circle the item description that most closely resembles the
patient’s highest functional level (either 0 or 1).
A. Ability to Use Telephone E. Laundry
1. Operates telephone on own 1 1. Does personal laundry completely 1
initiative-looks up and dials numbers, etc. 2. Launders small items, rinses socks, 1
2. Dials a few well-known numbers 1 stockings, etc.
3. Answers telephone, but does not dial 1 3. All laundry must be done by others 0
4. Does not use telephone at all 0
B. Shopping F. Mode of Transportation
1. Takes care of all shopping needs 1 1. Travels independently on public 1
independently transportation or drives own car
2. Shops independently for small 0 2. Arranges own travel via taxi, but does 1
purchases not otherwise use public transportation
3. Needs to be accompanied on any 0 3. Travels on public transportation when 1
shopping trip accompanied by another
4. Completely unable to shop 0 4. Travel limited to taxi or automobile 0
with assistance of another
5. Does not travel at all 0
C. Food Preparation G. Responsibility for Own Medications
1. Plans, prepares, and serves adequate 1 1. Is responsible for taking medication in 1
meals independently correct dosages at correct time
2. Prepares adequate meals if supplied 0 2. Takes responsibility if medication is 0
with ingredients prepared in advance in separate dosage
3. Heats and serves prepared meals or 0 3. Is not capable of dispensing own 0
prepares meals, but does not maintain medication
adequate diet
4. Needs to have meals prepared and 0
served
D. Housekeeping H. Ability to Handle Finances
1. Maintains house alone with occasional 1 1. Manages financial matters 1
assistance (heavy work) independently (budgets, writes checks,
2. Performs light daily tasks such as 1 pays rent and bills, goes to bank); collects
dishwashing, bed making and keeps track of income
3. Performs light daily tasks, but cannot 1 2. Manages day-to-day purchases, but 1
maintain acceptable level of cleanliness needs help with banking, major
4. Needs help with all home maintenance 1 purchases, etc.
tasks 3. Incapable of handling money 0
5. Does not participate in any 0
housekeeping tasks

Total Score: 2 – Low function, dependent

Arthur is not able to perform most instrumental activities of daily living without any
assistance. Using the Lawton-Brody IADL Scale, he is classified as low function, dependent.

XI. Geriatric Depression Scale

Question. Choose the best answer for how you felt over the past week Answer Score
1. Are you basically satisfied with your life? YES/ NO 1
Kuntento ka na ba sa iyong buhay?
2. Have you dropped many of your activities and interests? YES/No 1
Itinigil mo na ba ang karamihan ng iyong mga nakasanayang gawain?
3. Do you feel that your life is empty? Yes/NO 0
Sa iyong palagay, wala na bang kabuluhan ang iyong buhay?
4. Do you often get bored? Yes/NO 0
Madalas ka bang naiinip?
5. Are you in good spirits most of the time? YES/No 0
Madalas bang Mabuti ang iyong pakiramdam?
6. Are you afraid that something is going to happen to you? YES/No 1
Natatakot ka ba na maaaring may masamang mangyayari sa iyo?
7. Do you feel happy most of the time? YES/NO 0
Masayahin ka bang madalas?
8. Do you often feel helpless? Yes/NO 0
Hindi mo na ba kayang pasanin ang nangyayari sa iyong buhay?
9. Do you prefer to stay at home, rather than going out and doing new YES/No 1
things?
Mas gusto mo bang tumigil sa bahay kaysa lumabas at gumawa ng
ibang bagay?
10. Do you feel you have more problems with memory than most YES/No 1
people?
Sa iyong palagay, mayroon ka bang higit na problema sap ag-alala ng
mga bagay-bagay o mas makakalimutin kaysa sa ibang tao?
11. Do you think it is wonderful to be alive? YES/No 0
Ikaw ba ay natutuwa na buhay ka ngayon?
12. Do you feel pretty worthless the way you are now? Yes/NO 0
Pakiramdam mob a ay wala ka nang silbi sa ngayon?
13. Do you feel full of energy? YES/No 0
Puno ka ba ng kasiglaan?
14. Do you feel that your situation is hopeless? Yes/NO 0
Nakakaramdam ka ba ng kawalan ng pag-asa?
15. Do you think that most people are better off than you are? Yes/NO 0
Mas Mabuti ba ang kalagayan ng nakakarami kaysa sa iyo?

Score Interpretation
0-5 Normal
>5 Suggests depression

Total Score: 5 – Normal

Although Arthur is greatly affected by the effects of the stroke, he is not that sad and does
not become hopeless, after all. To him, seeing his children become successful and reach their
dream is his ultimate success. He mentioned, “ang tagumpay ng magulang ay nakikita sa
nararating ng kanyang mga anak”. He is not satisfied with life as of the moment since according
to him, he still has a lot of things to do in this world and has a lot of plans in his mind before he
suffered from a stroke. He mentioned he sometimes asks God why this happened to him.
Although he mentioned he is always moving on and moving forward. Using the Geriatric
Depression Scale, he is classified as normal.

XII. Mini-Mental Status Examination

Maximum Patient
Questions
Score Score
What is the year? Season? Date? Day? Month?
5 1 Ano ang petsa ngayon? Buwan? Taon? Araw? Panahon?
Wasn’t able to answer season.
Where are you now? State? Country? Town/city? Hospital? Floor?
Ano ang pangalan ng lugar na ito? Nasaang palapag kayo ngayon?
5 5
Nasaang kalye ang lugar na ito? Nasaan munisipio kayo ngayon?
Nasaang bansa kayo ngayon?
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The pateint’s response is
3 3
used for scoring. The examiner repeats them until patient learns all
of them, if possible
 Magsasabi ako ng tatlong bagay. Ulitin niyo ang tatlong ito
pagkatapos kong sabihin. Tandaan din ninyo ang gma ito dahil
ipapaulit ko ito mamya. (3 trials) MANGGA BOLA PERA
I would like you to count backward from 100 by sevens (93, 86, 79,
72, 65), Alternative: Spell WORLD backwards (D-L-R-O-W)
5 5 Baybayin niyo ang salitang K-A-R-N-E. Pagkatapos baybayin ninyo
ng pabaligtad ang mga letra ng salitang KARNE (E-N-R-A-K)
Response: E – N – R – K – A
Earlier I told you the names of three things. Can you tell me what
those were?
3 0
Ano-ano ang tatlong bagay na pinatandaan ko sa inyo kanina?
Response: MANGGA only
Show the patient two simple objects, such as a wristwatch and a
pencil, and ask the patient to name them
2 2
Ano ang tawag dito (ituro ang lapis o bolpen)? Ano ang tawag dito
(ituro ang relo)?
Repeat the phrase: “No ifs, ands, or buts”
1 0
Ulitin ninyo ang sasabihin kong ito. “Wala nang papero-pero pa”
Follow my instructions: Take the paper using your left hand, fold it
in half, and put it on your lap
3 3 Gawin ninyo ang sasabihin ko, Pakinggan ninyo bago gawin.
Kunin ninyo ang papel gamit ang inyong kaliwang kamay, tikulpin
sa gitna, at ilagay iyon sa inyong kandungan
Please read this and do what it says. “Close your eyes”
1 1 Basahin ninyo ito at gawin niyo ang sinasabi “Ipikit mo ang iyong
mata”
Make up and write a sentence about anything (the sentence must
have a noun and a verb)
Magsulat kayo ng isang pangungusap.
1 1

Please copy this picture

Kopyahin ninyo ito

1 1
 Method Score Interpretation
Single Cutoff <24 Abnormal
<21 Increased odds of dementia
Range
>25 Decreased odds of dementia
21 Abnormal for 8th grade education
Education <23 Abnormal for high school education
<24 Abnormal for college education
24-30 No cognitive impairment
Severity 18-23 Mild cognitive impairment
0-17 Severe cognitive impairment

Total Score: 22– Mild cognitive impairment

XIII. Modified Caregiver Strain Index

YES, ON
YES, NO
REGULAR
SOMETIMES HALOS
BASIS
PAMINSAN HINDI
MADALAS
MINSAN (2) (1)
(3)
1. My sleep is disturbed
Naabala ang aking pagtulog dahil sa ✔
pag-aasikaso sa pasyente
2. Caregiving is a physical strain
Ang pag-aalaga sa aking pasyente ay
✔
nakakapagod dahil sa pagkarga, pag-alalay at
pag-aasikaso
3. There have been family adjustments.
Ang pag-aalaga sa aking pasyente ay nagdulot
✔
ng mga pagbabago sa buhay ng aking pamilya
dahil sa nagulong pang-araw araw na gawain
4. Caregiving is inconvenient
Nauubos ang aking pansariling oras sa ✔
pag-aalaga ng aking pasyente
5. There have been changes in personal plans
Ang pag-aalaga sa aking pasyente ay nagdulot
ng mga pagbabago sa aking plano sa buhay
✔
tulad ng pagpalit o pagtigil sa trabaho o
pag-aaral, paglabas-labas, pagbabakasyon,
atbp.
6. There have been other demands on my time
Bukod sa pag-aalaga, mayroon pang dumagdag
✔
na responsibilidad na nangangailangan din ng
aking oras
7. There have been emotional adjustments ✔
Ang pag-aalaga sa aking pasyente ay
nagnangailangan ng tibay ng loob dahil sa hindi
naiiwasang mga alitan at hindi
pagkakaunawaan
8. It is upsetting to find the person I care for has
changed so much from his/her former self
Ako ay nalulungkot dahil Malaki na ang ✔
ipinagbago ng aking pasyente mula nang siya ay
magkasakit
9. Some behavior is upsetting
May mga pagkakataon na nauubos ang aking
✔
pasensya at ako ay naiinis dahil sa asal ng aking
pasyente
10. I feel completely overwhelmed
Lubos akong nag-aalala kung paano ko ✔
makakayanan ang sitwasyong ito
11. Caregiving is a financial strain
Malaki na ang aking gastusin dahils a ✔
pag-aalaga

Score Interpretation
11-23 Normal
24-28 Predisposition to strain
29-33 Severe caregiver strain

Total Score: 21 – Normal

Grace is the primary caregiver of Arthur. According to her, at first it is really hard to
adjust since Arthur has always been the “maliksi, matikas, maparaan” one. However, as time
went on she’s able to get along with it and taking care of Arthur has become a fulfilling task.
Arthur is not that hard to take care of according to her. Using the Modified Caregiver Strain
Index, Arthur is classified to be normal.

XIV. Fall Risk Assessment

Age
✔ 60 - 69 years (1 point)
1
• 70 - 79 years (2 points)
• greater than or equal to 80 years (3 points)
Fall History
0
• One fall within 6 months before admission (5 points)
Elimination, Bowel and Urine
• Incontinence (2 points)
0
• Urgency or frequency (2 points)
• Urgency/frequency and incontinence (4 points)
Medications: Includes PCA/opiates, anticonvulsants, anti-hypertensives,
diuretics, hypnotics, laxatives, sedatives, and psychotropics
✔ On 1 high fall risk drug (3 points) 3
• On 2 or more high fall risk drugs (5 points)
• Sedated procedure within past 24 hours (7 points)
Patient Care Equipment: Any equipment that tethers patient (e.g., IV infusion,
chest tube, indwelling catheter, SCDs, etc.)
• One present (1 point) 0
• Two present (2 points)
• 3 or more present (3 points)
Mobility (multi-select; choose all that apply and add points together)
✔ Requires assistance or supervision for mobility, transfer, or ambulation (2
points) 4
✔ Unsteady gait (2 points)
• Visual or auditory impairment affecting mobility (2 points)
Cognition (multi-select; choose all that apply and add points together)
• Altered awareness of immediate physical environment (1 point)
0
• Impulsive (2 points)
• Lack of understanding of one's physical and cognitive limitations (4 points)

Score Interpretation
6-13 Moderate Fall Risk
>13 High Fall Risk

Total Score: 8– Moderate Fall Risk

Arthur currently has no history of falls. However, he already has difficulty with
ambulation. However, based on the fall risk assessment, he has a Moderate Fall Risk.

XV. Mini Nutritional Assessment

A. Has food intake declined over the past 3 months due to loss of appetite,
digestive problems, chewing or swallowing difficulties?
0 = severe decrease in food intake 2
1 = moderate decrease in food intake
2 = no decrease in food intake
B. Weight loss during the last 3 months
0 = weight loss greater than 3 kg (6.6 lbs)
1 = does not know 3
2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs)
3 – no weight loss
C. Mobility
0 = bed or chair bound
2
1 = able to get out of bed/chair but does not got out
2 = goes out
D. Has suffered psychological stress or acute disease in the past months?
0 = yes 2
2 = no
E. Neuropsychological problems
0 = severe dementia or depression
1
1 = mild dementia
2 = no psychological problems
F1 Body Mass Index (BMI) (weight in kg) / (height in m2)
0 = BMI less than 19
1 = BMI 19 to less than 21 3
2 = BMI 21 to less than 23
3 = BMI 23 or greater

Score Interpretation
12-14 Normal nutritional status
8-11 At risk of malnutrition
0-7 Malnourished

Total Score: 13 – Normal nutritional status

Arthur is a meat lover and occasionally eats vegetables. He has no food allergies. No
recent decreased intake or loss of appetite and no weight loss. Early post-stroke, he lost a lot of
weight and had a normal BMI. However, as time goes on, he regained his usual weight and now
weighs 75kg. He is classified as Overweight using the Asia Pacific Classification. (Weight: 75
kg, Height: 175 cm, BMI: 24.5 kg/m2)Overall, based on the Mini Nutritional Assessment, he
has normal nutritional status.

XVI. Environmental / Household Checklist

● House: residential, owned, concrete, bungalow (4 bedrooms, 2 bathrooms, 2 kitchen,
well-lit, well-ventilated)
● Lighting and water: legal provider, drinking water- mineral water from a water station
near their home (not boiled)
● Toilet: water sealed
● Disposal: covered and collected twice weekly
● Drainage: satisfactory
● Insect/vermin: cockroach, ants, termites-controlled, rats (from farm)
● Animals: 10 pet dogs (7 huskies, 1 pomeranian, 2 labradors) – vaccinated, tick
controlled
● Curtains: Cleaned once weekly, change curtains once a month
● Neighborhood: residential
● Accessibility: Near hi-way, accessible by car, tricycle, jeepney
● Appliances: television, electric fans, air conditioner, stove, refrigerator, microwave,
computer, home theater
● Beddings: soft beddings
 GERIATRIC ASSESSMENT / MANAGEMENT PLAN
Last Name: Date: ❑ In Patient
VILLAROMAN 01/27/2022 ✔ Out Patient
Patient First Name: ✔ Male Age: 68
Name ARTHUR ❑ Female
Middle Name: Birthdate: Civil Status:
YANGO 08/25/1953 Married
Address: Religion: Contact No.
Bardias, Villarosa, Licab, Nueva Ecija Roman Catholic 09483163010

ASSESSMENT / GERIATRIC SYNDROMES

Post-stroke (2016)
Hypertension Stage II, controlled
Dyslipidemia, controlled
Overweight (BMI: 24.5)

REVIEW OF MEDICATIONS / ASSESSMENT TOOLS

Telmisartan 80mg OD
Clonidine 150mg TID
Amlodipine 5mg OD
Metoprolol 50mg BID
Atorvastatin 40mg OD
Clopidogrel 75mg OD
Family APGAR (7) – Moderately dysfunctional
SCREEM Family Resources Survey (34) – adequate family resources
Katz Index of Independence in Activities of Daily Living (4) – moderate impairment
Lawton-Brody Instrumental Activities of Daily Living (2) – low function, dependent
Geriatric Depression Scale (5) – normal
Mini Mental Status Exam (22) – mild cognitive impairment
Modified Caregiver Strain Index (21) – normal
Fall risk Assessment (8) – Moderate Fall Risk
Mini Nutritional Assessment (13) – Normal nutritional status

IMMUNIZATION / PSYCHOSOCIAL INTERVENTION

Continue updating immunizations: Annual influenza vaccination, COVID-19 booster shot, Family
counseling

SCREENING
Daily BP monitoring twice a day (Morning and Evening)
Regular monitoring of CBC with platelet count, FBS, lipid profile, serum creatinine, urinalysis, liver
enzymes and electrolyte panel, every 3 months as instructed by primary care physician
For Ophthalmologic exam every year for hypertensive retinopathy screening

EDUCATION / COUNSELING
Medications: Compliance to daily medications, reminders to take medications at appropriate times of
the day
Diet Prescription: 2000 kcal/day, 0.8 g/kg IBW/day CHON, 60% high biologic value, nonprotein
calories divided into 60% CHO and 40% fats, <7% saturated fats, < 2 g sodium/day, < 200 mg
cholesterol/day, divided into 3 meals and 2 snacks, low fat, low salt, avoid sugary or starchy food, to
avoid gout: limit Organ and glandular meats (pinapaitan, bopis) liver, kidneys, red meat, seafood,
high-purine vegetables, alcohol.
Exercise Prescription: 30 mins of mild aerobic exercise (walking, stationary bike) 3 times in a week
Referrals: Patient may also be referred to an occupational therapist to help patient increase frequency
of physical activities and improve activities of daily living
Counseling: Home and Environmental modification for fall prevention

Prepared by: Noted by:

PGI Angelo D. VIllaroman . FMROD Mara Almazora .

Postgraduate Intern Family Medicine Resident / Consultant
(Signature over Printed Name) (Signature over Printed Name)