GERIATRIC ASSESSMENT

Jane Courtney
 family
Community support
nurses
Speech therapist

pharmacist
dietician
Multi-disciplinary team
Multi-disciplinary team

geriatrician
physiotherapist

Local doctor
Occupational therapist
psychologist
 World Health Organization definitions of disability.
• Disease—an intrinsic pathology or disorder . . . [which] may
or may not make [itself] evident clinically
• Impairment—a loss or abnormality of structure or function at
the organ system level
• Disability—a restriction or lack of ability to perform an
activity in a normal manner, a disturbance in the performance of
daily tasks
• Handicap—a disadvantage resulting from impairment or
disability that limits or prevents fulfillment of a role that is
normal
PATHOLOGY
(DISEASE)

IMPAIRMENT
(SYMPTOMS & SIGNS)

DISABILITY
(FUNCTIONAL LOSS)

HANDICAP
(SOCIAL CONSEQUENCES)
 DIAGNOSES DISABILITIES

Rheumatoid arthritis Poor mobility

Pain
Poor hand function
Carcinoma of prostate Incontinence
TURP Hot flushes
Radiotherapy Faecal urgency
Hormonal therapy Pain
Skeletal metastases
 ACTS OF DAILY LIVING (ADL’s)

MOBILITY- independent TRANSFERS- independent

with aid ( ) assist
assist not
wheelchair
bedbound

TOILET USE- independent GROOMING- independent

assist assist
not not
SHOWERING- independent DRESSING- independent
assist assist
not not

FEEDING- independent CONTINENCE- bladder

assist bowels
not
COGNITION - MEMORY
PROBLEM SOLVING
SOCIALISATION
BEHAVIOUR

DOMESTIC FUNCTIONS- SHOPPING

COOKING
CLEANING
TRANSPORT
BARTHEL ADL index

FUNCTIONAL INDEPENDENCE MEASURE (FIM)

MINI MENTAL STATE EXAM MMSE (FOLSTEIN’s)

GERIATRIC DEPRESSION SCALE (GDS)

FIM (motor)

Self-care
A.Self-care
B.Grooming
C.Bathing
D.Dressing upper body
E.Dressing lower body
F.Toileting
Sphincter control
G.Bladder management
H.Bowel management
Mobility (transfer)
I.Bed, chair, wheelchair
J.Toilet
K.Tub, shower

Locomotion
L.Walk/wheelchair
M.Stairs
FIM(cognitive):
Communication
N.Comprehension
O.Expression

Social cognition
P.Social integration
Q.Problem solving
R.Memory
 Score: 1 – 7 for each of 18 items (126)

Independence: 7—complete independence (timely, safely)

6—modified independence (device used)
Modified dependence: 5—supervision
4—minimal assistance (>75% of task)
3—moderate assistance (50%-74% of task)
2—maximal assistance (25%-49% of task)
Complete dependence: 1—total assistance (subject performs <25% of task)
 MMSE
1 ORIENTATION- TIME (5)
2 ORIENTATION – PLACE (5)
3 REGISTRATION (3)
4 CALCULATION (5)
5 RECALL (3)
6 NAMING (2)
7 “NO IF ANDS OR BUTS” (1)
8 “3 STAGE COMMAND” (3)
9 “CLOSE YOUR EYES” (1)
10 WRITE A SENTENCE (1)
11 PENTAGONS (1)
GERIATRIC DEPRESSION SCALE
WHAT DO WE DO WITH THIS ASSESSMENT?

PLAN CARE
Rehabilitation is a problem solving and educational
process aimed at reducing the disability and handicap
experienced by someone as a result of a disease,
always within the limitations of available resources.
(ICIDH quoted in “oxford textbook of geriatrics”.)
1 assess- identify, analyze &measure problems
2 plan- analyze problem(s) & set goals
3 treat- intervene to reduce disability & handicap
4 care- intervene to alleviate consequences of
disability
5 evaluate- check effectiveness
 AGED CARE ASSESSMENT TEAM (ACAT)

ASSESS FOR APPROVAL OF GOVERNMENT FUNDING FOR CARE

CO-LOCATED IN GERIATRIC DEPARTMENTS.