Arden L Aylor, MD Geriatrics

 Health Maintenance  Quick office screening tools  Advance Directives  Driving issues  Care types  Placement

 Primary and secondary disease prevention screening  Control chronic medical problems  Bi-annual medication review  Optimize function: cognitive, auditory, vision, fall screening  Assess for adequate support system  Discuss and document Advanced Directives

 Auditory - annual  Vision - annual  Fall risk  Cognitive screen

 Vital Signs/ Orthostatic  Neurologic assessment  Musculoskeletal assessment  Medications  Footwear  Cognitive assessment  Functional Reach Test

Falls in past year? No fallsNo Intervention Recurrent falls Single fall Fall Evaluation Gait & balance problem YesNo

 Single item test: quick screen for balance problems in older adults  Interpretation: Score of 6 or less indicates a significant increased risk for falls >70% fall in 3 months Score between 6-10 inches indicates a moderate risk for falls

 MMSE  MoCA (Montreal Cognitive Assessment)  Clock  Score (4-1)

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 Specific rules for older drivers Renewal is every 2 years for those 85 and older Mail, phone, and electronic renewal are not available for those 79 and older  Renewal conditions: In person  Vision test: At in-person renewals  Written test: No  Road test: No, unless there is a concern (mental or physical) regarding the driver's ability to safely operate a motor vehicle TxDOT

 Adequate support system  Legal Directives  Wills  Financial  Medical Directive  DNR/DNI

 Home Health Care is skilled nursing need  All Medicare beneficiaries can receive home health  Physical Therapy  Skilled Nursing  Respiratory Care  Medical Equipment  Infusion Therapy  Nursing aid - ADLs  No 24/7 care coverage

 Level A: Resident may require minimal assistance with ADL, must be mobile, may receive home health services  Level B: Resident may receive full assistance with ADL  Resident may be semi-independent and may require the assistance for transfers or to evacuate the facility  Resident may receive assistance with medication  Level C: Resident receive full assistance with ADL  Caregiver 24hrs on sight

 Patients need to go to hospital for nursing home placement

 Skilled Nursing Facility (short-stay): 1-6 months  Terminally ill  Short term rehabilitation  Debilitated post-acute care hospitalization  Nursing Home (long-stay): 6 months to years  Primarily cognitively impaired  Significant impairments of both cognitive and physical functioning  Primarily physically impaired

 Verify transfer or admission orders from the transferring facility  Perform history and physical within 48 hours of admission  Schedule regular reassessments (CMS) mandate: minimum every 30 days x90 days, then every 60 days Texas Department of Aging and Disability Services Revision: 08-5

 Focuses on improving the quality of life of people facing serious illness  Emphasis is placed on pain and symptom management  Goal is to improve the patients ability to tolerate medical treatments

 Hospice care is end-of-life care  Terminal diagnosis with life expectancy <6 months  Offering medical, psychological and spiritual support  No invasive treatment or PT/OT  Goal to help people who are dying have peace, comfort and dignity  Where: Home, Nursing Home, Hospital, Hospice respite center

 Advance Directive should be assessed and updated annually  Quick screen tools and be helpful in evaluating function  Patients need not go to hospital for nursing home placement  Palliative offers some degree of therapy  Hospice comfort care

Texas Department of Aging and Disability Services Revision: American Geriatric Society, 2011 americangeriatrics.org Center for Medicaid and Medicare Services, 2011 cms.gov Trailblazers CMS Texas, 2010 trailblazerhealth.com Federal Government Publication and statistics, 2010 gov/employees/govpubs/Pages/FederalGovernmentPublications.as px TxDOT, 2011 txdot.gov