physician evaluation at nursing home admission

History

• reason(s) for seeking admission
• status of active medical problems
• functional status
  • basic activities of daily living (bADL)
  • instrumental activities of daily living (iADL)
• past medical history
  • chronic medical conditions
  • surgical procedures
• preventative care
  • vaccinations
  • dental care
  • optometry
  • podiatry
• medications
• review of systems

Physical examination

• traditional physical examination
• additional components
  • orthostatic changes in blood pressure
  • nutritional status
  • screening for hearing problems
    • audiometry may be helpful
  • visual capabilities
  • mobility
    • direct observation of the ability to walk or transfer
    • Tinetti balance & gait testing may be useful
  • cognitive function
    • standardized cognitive assessment may be useful (Folstein mini mental status examination (MMSE))
  • affective status
    • standardized testing may be useful (geriatric depression scale (GDS))

Notes

Functional status

• basic activities of daily living
• instrumental activities of daily living

Socioeconomic status

• nature of family relationships
• relevant financial information
  • private pay
  • Medicaid
  • Medicare

Advance directives

• designation of proxy decision maker
• intensity of care desired

Additional terms

• activities of daily living (ADL)
• annual physician review of long term nursing home residents
• Folstein Mini-Mental Status Examination (MMSE)
• geriatric depression scale (GDS)
• medical progress notes on nursing home residents
• minimum data set (MDS) for nursing home residents
• Tinetti gait & balance evaluation