1. Rapid Geriatric Assessment and other Tools from Saint Louis University
Leslie Eber MD CMD

2. Rapid Geriatric Assessment
FRAIL Screening Tool
SARC-F Screening Tool for Sarcopenia
SNAQ – Simplified Nutritional Assessment Questionnaire
Rapid Cognitive Screen

3. 5PUBM 4"3$-' 4DPSF: @@@@@@@@@@
Saint Louis University
Rapid Geriatric Assessment*
*There is no copyright on these screening tools and they may be incorporated into the Electronic Health Record without permission and at no cost.
ID#: Sex: Age: Primary Care Provider Y / N Ethnicity (circle): African/Am Asian Caucasian Hispanic Non-Hispanic
The Simple “FRAIL” Questionnaire Screening Tool
SARC-F Screen for Sarcopenia
(Loss of Muscle)
Component Question
Fatigue: Are you fatigued?
Resistance: Cannot walk up one flight of stairs?
Aerobic: Cannot walk one block? Illnesses: Do you have more than 5 illnesses?
Loss of weight: Have you lost more than 5% of your weight in the last 6 months?
Strength
How much difficulty do you have in lifting and carrying 10 pounds?
Scoring: None = 0 Some = 1 A lot or unable = 2
Assistance in How much difficulty do you have
Walking walking across a room?
Scoring: None = 0 Some = 1 A lot , use aids or unable = 2
Rise from a Chair
How much difficulty do you have transferring from a chair or bed?
Scoring: None = 0 Some = 1 A lot or unable without
help = 2
Scoring: 3 or greater = frailty; 1 or 2 = prefrail
Climb stairs
How much difficulty do you have climbing a flight of ten stairs?
From Morley JE, Vellas B, Abellan van Kan G, et al. J Am Med Dir Assoc 2013;14:
Scoring: None = 0 Some = 1 A lot or unable = 2
Falls
How many times have you fallen in the last year?
Scoring: None = Falls = 1 4 or more falls = 2
Total score of 4 or more indicates Sarcopenia
5PUBM '3"*- 4DPSF:
From Malmstrom TK, Morley JE. J Frailty and Aging 2013;2:55-6.
5PUBM 4"3$-' 4DPSF:
SNAQ (Simplified Nutritional Assessment Questionnaire)
Rapid Cognitive Screen (RCS)
Please remember these five objects. I will ask you what they are later.
[Read each object to patient using approx. 1 second intervals.]
Apple Pen Tie House Car
[Give patient pencil and the blank sheet with clock face.] This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock
. [2 pts/hr markers ok; 2 pts/time correct]
My appetite is
Food tastes
very bad
bad
average
good
very good
Normally I eat
Less than one meal a day
One meal a day
very poor
poor
average
good
very good
When I eat
I feel full after eating only a few mouthfuls
I feel full after eating about a third of a meal
I feel full after eating over half a meal
I feel full after eating most of the meal
I hardly ever feel full a. a.
. What were the five objects I asked you to remember?
[1 pt/ea] b. b.
. I’m going to tell you a story. Please listen carefully because afterwards, I’m going to ask you about it. c. c.
Two meals a day
Jill was a very successful stockbroker. She made a lot of money on the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then
stopped work and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after.
What state did she live in? [1 pt]
SCORING d. d.
Three meals a day e. e.
More than three meals a day
Scoring: a=1, b=2, c=3, d=4, e=5.
A score <14 indicates significant risk of at least 5% weight loss within 6 months.
8-10……...
6-7……….
0-5……….
Normal
Mild Cognitive Impairment Dementia
From Wilson et al. Am J Clin Nutr 2005;82:
From Malmstrom TK, Voss VB, Cruz-Oliver DM et al J Nutr Health Aging 2015;19:
5PUBM 3$4 4DPSF:
5PUBM 4/"2 4DPSF:
Advance Directive
Do you have an advance directive? Y/N
Are you lonely? Y/N
3FWJTFE 8/27/2019

4. Frailty – Why does it matter
is a medical syndrome marked by reduced physiologic function, which increases the risk of vulnerability and short- term mortality, particularly in the face of a stressor. Frailty has been shown to predict poor outcomes including falls, disability, major morbidity following surgery, and mortality among older adults
Translating Frailty Research Into Clinical Practice: Insights From the Successful Aging and Frailty Evaluation Clinic:M. Huisingh-Scheetz et al. / JAMDA 20 (2019) 672e678

5. Frailty – Why does it matter
Frailty as accumulation of deficits: “the more things that are wrong, the more likely that person is frail” (Rockwood 2007)
Frailty as a biologic syndrome of decreased reserve resulting from cumulative declines across multiple physiologic systems (Fried et al. 2001)

6. Frailty – Why does it matter
It is estimated about 10% of older Adults are Frail
Frailty is also associated with other adverse outcomes including geriatric syndromes (falls, delirium, immobility, incontinence, dementia), poor surgical outcomes, hospitalization and death
There are many tools to assess Frailty

7. The Simple FRAIL Questionnaire Screening Tool
Fatigue: Are you fatigued?
Resistance: Cannot walk up one flight of stairs?
Aerobic: Cannot walk one block?
Illness: Do you have more then 5 illnesses?
Loss of Weight: Have you lost more than 5% of your weight in the last 6 months?
Scoring: 3 or greater- Frailty Prefrail

8. FRAIL-NH Tool

9. Sarcopenia
The loss of muscle mass, muscle strength and physical function
Associated with adverse outcomes such as falls, functional disability, poor quality of life and increased risk of death
Is an independent risk factor for falls, fractures and mortality
Highly prevalent in older nursing home residents (over 40%)
Malnutrition may be an independent risk factor
Prevalence and Associated Factors of Sarcopenia in Nursing Home Residents: A Systematic Review and Meta-analysis: Y. Shen et al. / JAMDA 20 (2019) 5-13

10. SARC-F Screening Tool for Sarcopenia score of 4 or more = Sarcopenia

11. SNAQ – Simplified Nutritional Assessment Questionnaire
My appetite is
Very poor
Poor
Average
Good
Very good
When I eat, I feel full after
Eating only a few mouthfuls
Eating about a third of a plateful
Eating over half a plateful
Eating most of the food
Hardly ever

12. SNAQ – Simplified Nutritional Assessment Questionnaire
Food tastes
Very bad
Bad
Average
Good
Very good
Normally I eat
Less than one full meal a day
One meal a day
Two meals a day
Three meals a day
More than three meals a day, including snacks

13. SNAQ – Simplified Nutritional Assessment Questionnaire
Scoring:
a=1 b=2 c=3 d=4 e=5
A score of <14
- indicates significant risk of at least 5% weight loss within the next 6 months

14. Rapid Cognitive Screen
Please remember these five objects. I will ask you what they are later.
[Read each object to patient using approx. 1 second intervals.]
Apple Pen Tie House Car
[Give patient pencil and the blank sheet with clock face.] This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock
. [2 pts/hr markers ok; 2 pts/time correct]
What were the five objects I asked you to remember? [1 pt/ea]
I’m going to tell you a story. Please listen carefully because afterwards, I’m going to ask you about it.
Scoring: 8-10: Normal
6-7: Mild Cognitive Impairment 0-5: Dementia

15. Rapid Geriatric Assessment
See it on YouTube at
Less then 5 minutes to complete

16. Treatable Causes of Dementia
Drugs
Emotional (Depression)
Metabolic (TSH) Eyes and Ears NPH
Tumors Infection Anemia (B12) Sleep Apnea

17. Weight Loss: Meals on Wheels
Medications producing anorexia Emotional –Depression
Abuse: elderly alcoholism Late life paranioa Swallowing problems Oral problems Nosocomial infections
Wandering and other dementia related problems Hypothyroidism, hypercalcemia, hyperglycemia, Hypoadrenalism Enteral problems: celiac disease
Low salt, sugar, cholesterol diets
Stones - cholecystitis

18. Fatigue
Depression Sleep Apnea Hypothyroidism Vitamin B12 Anemia Hypotension