GERIATRIC ASSESSMENT Jane Courtney

Multi-disciplinary team Local doctor nurses Speech therapist dietician physiotherapist Occupational therapist pharmacist Community support family geriatrician Multi-disciplinary team 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)

DIAGNOSESDISABILITIES Rheumatoid arthritis Poor mobility Pain Poor hand function

Carcinoma of prostate TURP Radiotherapy Hormonal therapy Skeletal metastases Incontinence Hot flushes Faecal urgency Pain

MOBILITY- independent with aid ( ) assist wheelchair bedbound TRANSFERS- independent assist not TOILET USE- independent assist not GROOMING- independent assist not SHOWERING- independent assist not DRESSING- independent assist not FEEDING- independent assist not CONTINENCE- bladder bowels ACTS OF DAILY LIVING (ADL’s)

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)

Self-care A.Self-care B.Grooming C.Bathing D.Dressing upper body E.Dressing lower body F.Toileting FIM (motor)

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.