Gateway Geriatric

Education Center

Saint Louis University

Division of Geriatric Medicine

Enhancing Geriatric Care by

Primary Care Health

Professionals

“The trouble is, old age is not interesting until

one gets there. It is a foreign country with an

unknown language to the young and even the

middle-aged.”

-May Sarton

-As We Are Now

Geriatric Workforce

Decline in Geriatricians in the United States

1988 2030

Geriatricians 7,128 7,750

Geriatricians

per older adult

1 for

every

2,546

1 for

every

4,254

Geropsychiatrists 1,596 1,659

Geriatric Assessment

• Geriatric Assessment is a systematic, interprofessional

approach to the older patient

– Diagnose geriatric syndromes

– Develop targeted treatment plans

– Improve patient outcomes

• Focus on function and quality of life

• Not based on chronological age but functional impairment

and risk of future decline

N Engl J Med. 1984 Dec 27;311(26):1664-70.

Effectiveness of a geriatric evaluation unit. A randomized clinical trial.

Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL.

At one year, patients who had been assigned

to the geriatric unit had much lower mortality

than controls (23.8 vs. 48.3 per cent, P less

than 0.005) and were less likely to have initially

been discharged to a nursing home (12.7 vs.

30.0 per cent, P less than 0.05) or to have

spent any time in nursing home (26.9 vs.

46.7 per cent, P less than 0.05).

Effect of inpatient rehabilitation specifically designed for geriatric patients on functional improvement and mortality at hospital discharge and at follow-up.

Stefan Bachmann et al. BMJ 2010;340:bmj.c1718©2010 by British Medical Journal Publishing Group

Function Mortality

Effect of inpatient rehabilitation specifically designed for geriatric patients on admissions to nursing homes at hospital discharge and at follow-up.

Stefan Bachmann et al. BMJ 2010;340:bmj.c1718

©2010 by British Medical Journal Publishing Group

J Am Geriatr Soc. 1999 Mar;47(3):269-76.

A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an

intervention to increase adherence to recommendations.

Reuben DB1, Frank JC, Hirsch SH, McGuigan KA, Maly RC.

• Physical functioning between treatment and control

groups indicated a significant benefit of treatment (P =

.021).

• Similar benefits were demonstrated for number of

restricted activity days and MOS SF-36 energy/fatigue,

social functioning, and physical health summary scales.

• The intervention, which prevented functional decline, cost

$273 per participant.

Yearly "Wellness" visits:

• If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors.

• Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit

• A review of your medical and family history• Developing or updating a list of current providers and prescriptions• Height, weight, blood pressure, and other routine measurements• Detection of any cognitive impairment• Personalized health advice• A list of risk factors and treatment options for you• A screening schedule (like a checklist) for appropriate preventive services.

Medicare

Annual Wellness Visit

Modern Giants of Geriatrics

Frailty

Sarcopenia

Anorexia of Aging

Cognitive Impairment

Rapid Geriatric Assessment

• Early detection of health problems when interventions are

most likely to be successful

• Used for common geriatric problems

• Ideally provide a brief, reliable method for detecting

common problems

• Track changes over time

How to Bill Medicare’s Annual Wellness Visit (AWV)

Diagnosis code V70.0; Initial Annual Wellness Visit

G0438; Subsequent Annual Wellness Visit G0439

Saint Louis University

Rapid Geriatric Assessment*

Miscellaneous

Are you constipated? Y/N

Do you have worrisome incontinence? Y/N

Do you have an advanced directive? Y/N

*There is no copyright on these screening tools and they may be

incorporated into the Electronic Health Record without permission and at no cost.

SNAQ (Simplified Nutritional Assessment Questionnaire)

My appetite is Food tastes

a. very poor a. very bad

b. poor b. bad

c. average c. average

d. good d. good

e. very good e. very good

When I eat Normally I eat

a. I feel full after eating a. less than one meal a day

only a few mouthfuls b. one meal a day

b. I feel full after eating c. two meals a day

about a third of a meal d. three meals a day

c. I feel full after eating e. more than three meals a day

over half a meal

d. I feel full after eating

most of the meal

e. I hardly ever feel full

__________________________________From Wilson et al. Am J Clin Nutr 2005;82:1074-81.

Rapid Cognitive Screen (RCS)

1. 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

2. [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]

3. What were the five objects I asked you to remember? [1 pt/ea]

4. I’m going to tell you a story. Please listen carefully because

afterwards, I’m going to ask you about it.

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]

______________________________________________

From MalmstromTK, Voss VB, Cruz-Oliver DM et al.

J Nutr Health Aging 2015;19:741-744.

The Simple “FRAIL” Questionnaire Screening Tool

(3 or greater = frailty; 1 or 2 = prefrail)

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?

_________________________________________________From Morley JE, Vellas B, Abellan van Kan G, et al. J Am Med Dir Assoc

2013;14:392-397.

Table I: SARC-F Screen for Sarcopenia

Component Question Scoring_________

Strength How much difficulty do you have in None = 0

lifting and carrying 10 pounds? Some = 1

A lot or unable = 2

Assistance in How much difficulty do you have None = 0

walking walking across a room? Some = 1

A lot, use aids, or unable = 2

Rise from a How much difficulty do you have None = 0

chair transferring from a chair or bed? Some = 1

A lot or unable without help = 2

Climb stairs How much difficulty do you have None = 0

climbing a flight of ten stairs? Some = 1

A lot or unable = 2

Falls How many times have you None = 0

fallen in the last year? 1-3 falls = 1

4 or more falls = 2

From Malmstrom TK, Morley JE. J Frailty and Aging 2013;2:55-6.

FRAILTY DEFINITIONS

“Occurs when under stressful conditions the person has

diminished ability to carry out important practiced

social activities of daily living.It needs to be distinguished

from disability”

Renoir, 1915

Blonde a la rosa

0 10 20 30 40 50 60 70 80 90 100

Age (years)

Cogn

itiv

e R

eser

ve

VO

2 m

ax

Car

dia

c outp

ut

Bal

ance

Musc

le s

tren

gth

Frailty

Threshold

Frailty CascadePSYCHOLOGICAL

Depression

Cognition

Anxiety

Fear of Falling

Fatigue

Health Perception

SOCIAL

Environment

Income

Support System

Health Literacy

Activity

BIOLOGICAL

Genetics

Muscle

Hormones

Cytokines

Disease

Deficits

FRAILTY

Functional Deficit

(IADLs/ADLs)

Hospitalisation

Nursing Home

Death

Fatigue

Resistance (1 flight stairs)

Aerobic (1 block)

Illnesses (>5)

Loss of weight (5%)

Criteria of

Internationl Academy of Nutrition and Aging, 2008

9-year OR of ADL deficit or Mortality

in persons not lacking ADLsADLs

PreFrail Frail p

FRAIL 2.74 20.76 .001

SOF 3.09 3.48 .001

CHS 2.40 6.47 .001

Rockwood 2.36 5.65 .001

MORTALITY

PreFrail Frail p

1.58 3.99 .001

1.47 1.40 NS

1.35 2.42 .01

2.50 2.66 .001

Specificity of Scales in

Hong Kong Study

MALE MALE FEMALE FEMALE

MORTALITY Physical Limit MORTALITY Physical Limit

Rockwood 96.4% 98.4% 93.8% 98%

CHS 99.2% 100% 99.4% 99.9%

FRAIL 99.1% 99.4% 99.9% 100%

Hubbard 98% 99.6% 96.1% 95.1%

All had poor Sensitivity

Algorithm for Management of Frailty

Fatigue

Resistance Aerobic

Illnesses

Loss of Weight

SLU “AM SAD” for depressionDo you stop breathing while asleep? Sleep apneaTSH for hypothyroidVitamin B12Hemoglobin for anemiaBlood pressure for hypotension/orthostasis

SARCOPENIA

Resistance exerciseAerobic exerciseProtein supplement daily1000 IU vitamin D daily

3 to 5 x week

Review medication list for unnecessary side effects and drugs whose side effects may be contributing to frailty, e.g., anticholinergic drugs

Medications producing anorexiaEmotional – depressionAbuse, elderly, alcoholismLate life paranoiaSwallowing problemsOral problemsNosocomial infections, eg, H PyloriWandering and other dementia-related problemsHyperthyroidism, hypercalcemia, hyperglycemia, hypoadrenalismEnteral problems, eg, celiac diseaseEating problemsLow salt, sugar and cholesterol dietsStones - cholecystitis

Caloric Supplementation

The American Journal of MedicineVolume 128, Issue 11, November 2015, Pages 1225–1236.e1

Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A

Randomized Controlled Trial

Tze Pin Ng, MDa, , , Liang Feng, PhDa, Ma Shwe Zin Nyunt, PhDa, Lei Feng, PhDa, Mathew Niti, PhDb, Boon Yeow Tan, MMEDc, Gribson Chan, MScc, Sue

Anne Khoo, MPsych(Clin)d, Sue Mei Chan, MHlthSc (Mgmt)d, Philip Yap, MRCPd, Keng Bee Yap, FRCP(Edin)e

Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial

The American Journal of Medicine, Volume 128, Issue 11, 2015, 1225–1236.e1

Results

Frailty score and status over 12 months were reduced in all groups,

including control (15%), but were significantly higher (35.6% to 47.8%) in

the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical

(OR 4.05) and combination (OR 5.00) intervention groups.

Beneficial effects were observed at 3 months and 6 months, and persisted

at 12 months.

Improvements in physical frailty domains (associated with interventions)

were most evident for knee strength (physical, cognitive, and combination

treatment), physical activity (nutritional intervention), gait speed (physical

intervention), and energy (combination intervention).

Conclusions

Physical, nutritional, and cognitive interventional approaches were

effective in reversing frailty among community-living older persons.

Is frailty among older individuals reversible

with nutritional, physical, or cognitive interventions, singly or in combination?

WARM-UP a PROPRIOCEPTION/BALANCE EXERCISES d STRETCHING

b AEROBIC TRAINING

c STRENGTH TRAINING

20R each arm

1

20R each arm

2

20R each foot

3

4

20R each leg

5

20R each leg

30s each leg

20R each leg

5

20R 20R

30s each foot in front

30s each foot in front nt

30s

6 7 8

30s each leg

4

1 1

20s each side

2

20s

3

20R forward + 20R back

5

20R each leg

20s each hand

4

6

2R x 20s each leg

3

20R

After 10 minutes After first 5 minutes 2

20R

After 15 minutes 4

Top 2 steps Walking

1

WITH ELASTIC BANDS

1 2 3 2 1 3

WITH BIG BALLS WITH SMALL BALLS

1 2 3

2 3

Tarazona-Santabalbina FJ, Gomez-Cabrera MC, Perez-Ros P et al. A Multicomponent exercise intervention that reverses frailty and improves cognitiion, emotional, and social networking in the community-dwelling frail elderly. A randomized clinical trial. J Am Med Dir Assoc 2016 (In press).

A multicomponent exercise intervention that reverses frailty

Tarazona-Santabalina et al, JAMDA In pressFried Frailty Criteria

0

0.5

1

1.5

2

2.5

3

3.5

4

Control Exercise

Basal Post

SPPB

0

1

2

3

4

5

6

7

8

9

10

Control Exercise

Basal Post

J Am Med Dir Assoc. 2015 May 1;16(5):439.e9-439.e16. doi: 10.1016/j.jamda.2015.02.005. Epub 2015 Apr 2.

Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status,

and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study.

Abizanda P1, López MD2, García VP3, Estrella Jde D4, da Silva González Á5, Vilardell NB6, Torres KA6.

Author information

Abstract

OBJECTIVES:

The objective of this study was to assess the effects of a hyperproteic, hypercaloric oral nutritional supplement with prebiotic fiber, vitamin D, and calcium, plus a standardized

physical intervention, in the functional status, strength, nutritional status, and quality of life of frail institutionalized older adults.

DESIGN:

Multicentric prospective observational study under usual clinical practice conditions.

SETTING:

Four nursing homes from Burgos (2), Albacete, and Madrid, Spain.

PARTICIPANTS:

Participants included 91 institutionalized older adults (age ≥70), able to walk 50 m, and meeting at least 3 of the Fried frailty phenotype criteria.

INTERVENTION:

Daily intake of two 200-mL bottles of an oral nutritional supplement, each bottle containing 300 kcal, 20 g protein, 3 g fiber, 500 IU vitamin D, and 480 mg calcium, plus a

standardized physical exercise training consisting of flexibility, balance, and strengthening exercises for arms and legs, 5 days per week.

MEASUREMENTS:

Short Physical Performance Battery (SPPB), Short-Form-Late-Life Function and Disability Instrument (SF-LLFDI) function subscale, handgrip strength, EuroQoL-5 Dimensions

visual analogic scale (EQ5DVAS), weight, body mass index (BMI), and Short-Form Mini Nutritional Assessment (MNA-SF) at baseline and 6 and 12 weeks.

RESULTS:

Forty-eight participants (52.7%) improved at least 1 point in the SPPB at week 6, and 44 (48.4%) did so at week 12; 39 participants (42.9%) improved at least 2 points in the SF-

LLFDI at week 6, and 46 (50.5%) at week 12. Participants improved their quality of life measured with the EQ5DVAS by 6% (95% confidence interval [CI] 3%-10%) at week 6, and

by 5% (95% CI 0%-10%) at week 12. They also improved their nutritional status (weight gain, BMI increase, and higher MNA-SF scores at 6- and 12-week follow-up). This

improvement was higher in participants with more frailty criteria, lower functional level, lower vitamin D levels, and poorer nutritional status.

CONCLUSION:

A 12-week intervention with oral nutritional supplementation plus physical exercise improves function, nutritional status, and quality of life in frail institutionalized older adults.

Frailty

n=4461

Participants with a total score higher than 4 were classified as having sarcopenia

Physical function as independent predictors of SARC-F ≥ 4 in multiple binary

logistic regression analysis

n B S.E. P OR 95% C.I. for OR

4m walking speed 202 -4.913 .851 .000 .007 0.001-0.039

TUG* completed 76 -4.018 .781 .000 .018 0.004-0.083

TUG time 25 .071 .022 .001 1.074 1.029-1.121

SPPB#

76 -.572 .084 .000 .565 0.479-0.665

Grip strength 28 -.139 .025 .000 .870 0.828-0.915

SARC-F CHENGDU

St Louis SARC-F Longitudinal

SARC-F in Baltimore Longitudinal Study

60+ years

Odds Ratio P-value

Gait Speed<0.8 m/s

9.41(2.51-35.27) 0.001

Mortality 3.07(1.60-5.73) 0.001

SARC-F

Odds Ratio for 4 year outcomes associated with

different sarcopenia definitions

Woo et al: Hong Kong Data

Males Females

Sarcopenia and DiabetesAfrican Americans 50 - 65 years

Diabetics who were SARC-F positive had a high risk of future ADL and IADL deficits

Kentaro Kamiya

Treatment for SARCOPENIA is

RESISTANCE EXERCISE

PROVIDE (PROTEIN) STUDY CENTRESACROSS EUROPE

Sarcopenia in SLU Diabetic ClinicSarcopenia(SARC-F) in Diabetic

Outpatients 6 months outcomes

• Hospital Utilisation:

3.735(1.649-8.458)

p<0.002

• Disability:

4.237(1.764-10.181)

p<0.001

Sarcopenia

n=4461

1) My appetite is1. Very poor

2. Poor

3. Average

4. Good

5. Very good

2) When I eat, I feel full after

1. Eating only a few mouthfuls

2. Eating about a third of a plateful

3. Eating over half a plateful

4. Eating most of the food

5. Hardly ever

3) Food tastes1. Very bad2. Bad3. Average4. Good5. Very good

4) Normally I eat

1. Less than one full meal a day

2. One meal a day

3. Two meals a day

4. Three meals a day

5. More than three meals a day, including snacks

S.N.A.Q

< 15 predicts significant

weight loss within 6 months

Mini-CNAQ: 5% weight loss

0.0

0.2

0.4

0.6

0.8

1.0

0.0 0.2 0.4 0.6 0.8 1.0

1-Specificity

Se

nsi

tiv

ity

Area Under Curve = 0.85, P < .001

0.0

0.2

0.4

0.6

0.8

1.0

0.0 0.2 0.4 0.6 0.8 1.0

1-Specificity

Sen

siti

vity

Area Under Curve = 0.87, P < .001

Total

old

0.0

0.2

0.4

0.6

0.8

1.0

0.0 0.2 0.4 0.6 0.8 1.0

1-Specificity

Sens

itivi

ty

Area Under Curve = 0.84, P < .001

young

SNAQ

Sensitivity

(%)

Specificity

(%)

5% weight loss 81.3 76.4

10% weight loss 88.2 83.5

Geriatr Gerontol Int. 2014 Dec 16. doi: 10.1111/ggi.12426. [Epub ahead of print]Reliability and validity of the Japanese version of the simplified nutritional appetite questionnaire in

community-dwelling older adults.Nakatsu N1, Sawa R1, Misu S1,2, Ueda Y1, Ono R1.

• The mean score of the Japanese version of the SNAQ was 15.5, with a Cronbach's alpha coefficient of 0.545 and intraclasscorrelation coefficient of 0.754.

• Factor analysis showed a single factor with 50.0% explained variance.

• The SNAQ was significantly associated with the Mini-Nutritional Short Form

• SNAQ (Japanese version) is useful for evaluating the appetite of community-dwelling older adults in Japan.

Fig. 2. Discriminate Simplified Nutritional Assessment Questionnaire (SNAQ) value for determining older people with or without a normal Mini-Nutritional

Assessment (MNA) (receiver operating characteristic [ROC] curve).

Yves Rolland, Amélie Perrin, Virginie Gardette, Nadège Filhol, Bruno Vellas

Screening Older People at Risk of Malnutrition or Malnourished Using the Simplified Nutritional Appetite Questionnaire (SNAQ): A Comparison With

the Mini-Nutritional Assessment (MNA) Tool

Journal of the American Medical Directors Association, Volume 13, Issue 1, 2012, 31–34

http://dx.doi.org/10.1016/j.jamda.2011.05.003

Measuring Appetite with the Simplified Nutritional

Appetite Questionnaire Identifies Hospitalised

Older People at Risk of Worse Health Outcomes

A.L. PILGRIM,1,2 D. BAYLIS,1 K.A. JAMESON,2 C.

COOPER,2 A.A. SAYER,1,2,3,4 S.M.

ROBINSON,1,2 and H.C. ROBERTS1,2,3,4

179 female participants mean age 87 (SD 4.7) years were

recruited

42% of participants had a low SNAQ score (<14,

indicating poor appetite).

A low SNAQ score was associated with an increased risk

of hospital acquired infection (OR 3.53; 95% CI: 1.48,

8.41; p=0.004) and with risk of death (HR 2.29; 95% CI:

1.12, 4.68; p = 0.023) by follow-up.

Medications

Emotional (depression)

Alcoholism,anorexia tardive, abuse (elder)

Late life paranoia

Swallowing problems

Oral problems

Nosocomial infections,no money (poverty)

Wandering/dementia

Hyperthyroidism,hypercalcemia,hypoadrenalism

Enteric problems (malabsorption)

Eating problems (eg. Tremor)

Low salt, low cholesterol diet

Shopping and meal preparation problems, Stones (cholecystitis)

Causes of Weight Loss

Morley JE, Silver AJ. Ann Intern Med 1995;123:850-859.

Families and physicians fail to recognize

dementia.

Mini-Mental Status ExaminationFolstein et al. 1975

1. Educationally dependent

2. Both false positives and false negatives

3. Minimal testing of visuospatial system

ROCs For SLUMS &MMSE for MCI > HS

Education

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

1-Specificity

Sen

sitiv

ity

Area Under Curve = 94.1%

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

1-Specificity

Sen

siti

vit

y

Area Under Curve = 64.3%

SLUMS MMSE

Am J Geriatr Psychiatry. 2006;14:900-910.

Rapid Cognitive Screen (RCS) - Dementia

DementiaScores ≤ 5 Sen=0.89,

Spc=0.94

AUC (95% CI)

RCS 0.98 (0.95-1.00)

Mini-Cog 0.92 (0.89-0.95)

Rapid Cognitive Screen and MCI(5 words, clock, story with country)

RCS vs MiniCogRCS

2.5 minutes to complete

MCI and Diabetes

Reversible Causes of MCI

D

E

M

E

N

T

I

A

rugs (digoxin, theophylline, cimetidine, anticholinergic

motional (depression)

etabolic (hypothyroidism)

yes and ears (sensory isolation)

ormal Pressure Hydrocephalus (ataxia, incontinence, and dementia)

umor or other space-occupying lesion

nfection (syphilis, chronic infections)

nemia (vitamin B12 deficiency)/Alcoholism

S leep Apnea

Mediterranean Diet associated with

reduced risk of Alzheimer’s Disease

Exercise and the Brain

Aerobic exercise for 6 months decreased

brain atrophy…..

Colcombe et al

J Gerontol A 2006; 61:1166

Increased cognition

Decreased dysphoria

LIFE Study suggests needFor HIGH DOSE exercise

Tiia Ngandu , Jenni Lehtisalo , Alina Solomon , Esko Levälahti , Satu Ahtiluoto , Riitta Antikainen , Lars Bäckma...

A 2 year multidomain intervention of diet, exercise, cognitive training, and

vascular risk monitoring versus control to prevent cognitive decline in at-risk

elderly people (FINGER): a randomised controlled trial

Aged 60-77 years recruited from previous national

surveys.

A 2 year multidomain intervention (diet, exercise,

cognitive training, vascular risk monitoring), or a

control group (general health advice).

1260 to the intervention group (n=631) or control

group (n=629).

FINGER STUDY

Management of Cognitive Dysfunction

Exclude Treatable Causes

• Anticholinergic drugs

• Depression

• Hypothyroid (TSH)

• Vitamin B12 deficiency

• Hearing and visual problems

• Atrial fibrillation

• Sleep Apnea

Lifestyle

• Mediterranean diet

• Olive oil

• Exercise

• Computer games

• Socialisation

• Cognition Stimulation Therapy

• Refer to Alzheimers Association

• Safe return bracelet

• Discuss driving/guns

Cognitive Stimulation Therapy : NHC Nursing Home

Cardinals Reminiscence League

0.0%

20.0%

40.0%

60.0%

80.0%

Screening Case Finding Nursing Homes PACE

Normal Cognition 54.4% 55.2% 15.0% 51.1%

MCI 21.8% 19.9% 14.8% 17.8%

Dementia 23.8% 24.8% 70.2% 31.1%

% o

f To

tal

RCSJuly 1, 2015 - December 31, 2016

Jean Woo , Ruby Yu , Moses Wong , Fannie Yeung , Martin Wong , Christopher Lum

Frailty Screening in the Community Using the FRAIL Scale

Elderly Centers in the New Territories East Region of Hong Kong SAR China.

Information Sheets are Available

for Older Persons who Screen Positive

for Frailty, Sarcopenia or Cognitive

Dysfunction

Frailty

Information Sheet

Your screening test indicates you may be experiencing frailty. Physical frailty is an important medical syndrome. It is defined as diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability to developing increased dependency or death.

It can be prevented or treated with aerobic and resistance exercise, protein-calorie supplementation, vitamin D, and a reduction of polypharmacy. To do this, please consider trying a few of the below exercises:

• Sit up from a chair five times• Use 5 lb weights to exercise your arms• Do aerobic workouts, such as 20 minutes of walking per day• Try standing on one foot while holding onto something and closing your eyes

Please see your physician for monitoring and treatment of your condition.

RCS Score _____/10

AD8 Score _____/8

Brain Health

Information Sheet

Your screening test shows you may be experiencing some mild cognitive impairment. While some forgetfulness is normal with age, there are some concerning signs, as well as a few reversible causes, and some treatments that may help conserve your mental status.

Early recognition of cognitive impairment can help doctors, caregivers, and family members in managing comorbid conditions and anticipating problems. While there may be pharmacological interventions for specific reversible causes of dementia, there are also some lifestyle adaptions that can help. Some changes along these lines are listed here:• Do brain games, such as crosswords or those available on computers• Eat plenty of fruits, vegetables, and whole grains. The Mediterranean diet might be a good place to start. Increasing

your intake of extra virgin olive oil is particularly helpful• Have your doctor check for treatable conditions• Stay active! Find a physical activity you like, whether it is walking, hiking, swimming, or something new. Try to do it for a

half hour, five times a week.• Be involved socially in the community, such as going on walks or to lunch with friends, doing volunteer work, or trying a

new hobby.

Please talk with your physician about possible causes, questions, and for monitoring your condition. There are a number of treatable causes of memory problems including depression, sleep apnea, hypothyroidism and vitamin B12 deficiency.

SARC-F Score ______/10

Sarcopenia Information Sheet

Your screening test has indicated you might have sarcopenia. Sarcopenia is a loss of skeletal muscle mass and function over time, and is correlated with physical disability, poor quality of life, and death. While it can sometimes cause weight loss, reduced muscle may be replaced by fat mass so that overall weight might not change. There are ways to stop sarcopenia in its tracks, and they focus mostly on exercise and nutrition interventions.

Here is a list of workouts that can be done to reduce and reverse sarcopenia. Resistance training exercises are especially important, either against body weight or with small weights.

• Sit up from a chair five times• Use 5 lb weights to exercise your arms• Do aerobic workouts, such as 20 minutes of walking per day• Try standing on one foot while holding onto something and closing your eyes• Take a high whey protein supplement once daily• Take 1000IU of vitamin D daily• Eat one yogurt at night before going to bed

Please consult your physician if you have any questions and for monitoring your condition.

Medicare Plans to Pay Doctors for Counseling on End of Life

Historic Human Mortality Rates

Do specific programs enhance outcomes?

Conclusion

• Rapid Geriatric Assessment can be completed within 4

minutes and used as major component of Medicare

Wellness Examination

• Simple guide to treatment and patient handouts available

• Medicare to pay for end of life discussion

Sulfonylureas and Insulin increase mortality in

diabetics; metformin doesn’t

Diabetics with autonomic neuropathy are at

increased risk for sudden death. Need an

implantable loop recorder?

Sleep apnea causes hypertension, hyperglycemia

and cognitive dysfunction

@meddocslu

All Materials Available for RGA

Aging.slu.edu