office-based geriatric assessment
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Indications
- functional decline with changes in physical, mental, & social status
Procedure
Assessment components:
- medical
- cognitive
- affective
- functional
- social support: caregiver
- economic
- environmental
- advance directives
- prevention
Prescreening questionnaire:
- review of systems
- activities of daily living (ADL)
- prevention
- advance directives
Directed medical history
- review questionnaire & medical records
- hospitalizations & emergency room visits
- surgeries
- review medications & compliance each visit, prescription & OTC, including herbal supplements
Directed physical examination
- guided by history/observation
- try to evaluate
- visual impairment
- hearing loss
- gait & balance
- dentition
- mood (geriatric depression scale)
- cognition/memory
- minimental status vs Montreal Cognitive Assessment (MoCA)
- clock test
- time & change test
- miniCog
- nutrition
- skin
- general: alertness, behavior, appearance
- cardiac: heart & carotid auscultation
- neurologic:
- focal neurologic signs
- signs of Parkinsonism
- rigidity, resting tremor, cogwheeling, bradykinesia
- orthostasis
Plan of action:
- establish agreement on plan of action
- review findings
- prioritize next steps
- legible instructions
- follow-up visit
- referrals as needed
- touch patient in closing
Notes
- attenuates functional decline at no additional cost
- no survival benefit demonstrated[4]
- no explicit Medicare reimbursement
More general terms
Additional terms
References
- ↑ Moore, AA. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Koretz BK & Moore AA, Assessment of the Geriatric Patient, JCOM 8(7): 35, 2001 (http://www.white-turner.com)
- ↑ Sloane PD Key Issues in the Primary Care of Alzheimer's disease In: Facilitating Diagnosis and Management of Alzheimer's Disease in the Primary Care Setting Internal Medicine World Report 20(11) suppl Nov, 2005
- ↑ 4.0 4.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - ↑ Li CM, Chen CY, Li CY, Wang WD, Wu SC. The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial. Arch Gerontol Geriatr. 2010 Feb;50 Suppl 1:S39-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20171455