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Slide 2 Evaluation of The Elder Patient David V. Espino, M.D. Vice Chair & Director, Div. Of Community Geriatrics Dept. of Family & Community Medicine University of Texas Health Science Cntr-San Antonio Slide 3 Elder Evaluation w Introduction w Evaluation w Review w Summary Slide 4 Aging w Is Not A Disease w Occurs at Different Rates Among Individuals Within Individuals w Increases Susceptibility to Specific Conditions Slide 5 Characteristics of Geriatric Medical Conditions w Chronic with Superimposed Acute Illness w Multiple and Coexisting Slide 6 Iatrogenesis w Medication Misuse w Hospitalization Falls, Delirium, Immobility w Diagnostic/ Therapeutic Procedures Slide 7 Presentation of Geriatric Patient w Typically Atypical w Nonspecific w Cascade Phenomenon Slide 8 Goals of Geriatric Care w Care vs. Cure Iatrogenesis w Function w Quality of Life w Prevention w Palliation Slide 9 Geriatric Money Balls w Small Changes In Function = Big QOL Gains w Taking Things Away Can Make Things Really Better or Really Worse! Slide 10 Elder Evaluation w Introduction w Evaluation w Orientation w Summary Slide 11 Geriatric Evaluation w Geriatric H&P w Functional w Cognitive/Affective w Medications w Nutritional w Bone Integrity/Falls w Strength/Sarcopenia w Continence w Eyes/Ears w ETOH/Tobacco/Sex w EnviroSocial w Capacity Slide 12 History: {Communication & Rapport} w Impaired Communication? w Eye Contact, Physical Contact w Use Last Name w Speak Directly to Elder Establish Decision Maker w Address CC w Make Only One Change/Visit Slide 13 Geriatric History w Avoid Open Ended Questions w Focus On Current Medical Problems w Address Families Concerns w Focus On Medications Slide 14 Physical Exam: Blood Pressure w Blood Pressure 24% of Elders have Orthostasis w Pseudohypertension w Trial of Hypertensives? 25% Normotensive Slide 15 Physical Exam: Height/Weight/Skin w Serial Heights w Serial Weights Essential w Skin Senile Lentigines, Skin Tags Physical Abuse Signs? Decubs? Examine at Annual Exam Slide 16 Physical Exam w Areas to Focus On Cardiovascular Musculoskeletal Neurological Thyroid? Slide 17 Functional Evaluation w Instrumental Activities of Daily Living (IADLs) w Activities of Daily Living (ADLs) w Executive Functioning w Gait & Balance Slide 18 Gait & Balance w Get Up and Go ! w Tinetti Gait & Balance Slide 19 Cognitive/Affective Status w Folsteins MiniMental State Exam (MMSE) w Clock Drawing w Geriatric Depression Scale (GDS) Slide 20 Mini Mental State Exam [ General Information ] w Developed by Marshall Folstein in 1975 w Estimate Severity of Cognitive Impairment w NOT Designed To Make Specific Diagnoses Slide 21 MMSE [Cognitive Domains] w Orientation/Time5 points w Orientation/Place5 points w Registration3 points w Attention/Calculation5 points w Recall of Three Words3 points w Language8 points w Visual Construction1 point Slide 22 MMSE [Scoring / Cutoffs] w Total Number of Correct Answers w 24-30 CorrectNo Cognitive Imp. w 18-23 CorrectMild Cognitive Imp. w 0-17 CorrectSevere Cog. Imp. Slide 23 MMSE [Influences] w Educational Level w Race / Ethnicity w Socioeconomic Status? Slide 24 Clock Drawing Test w Different Versions w 4 Point Scale Most Useful 1 Point- Circle 1 Point-Numbers 1 Point-Hands/Arrows 1 Point-Right Time Slide 25 Geriatric Depression Scale [ General Information ] w Total Number of Questions w Long Version = 30 w Short Version = 15 w Administered in about 5 Minutes w Count the Missed Questions Slide 26 Geriatric Depression Scale [ Error Cut-Offs ] w Long Version < 11 Not Depressed 11-14 Possible Depression 14 Depression w Short Version