Geriatric Examination and Intervention

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Author:
dmshaw9
ID:
239108
Filename:
Geriatric Examination and Intervention
Updated:
2014-02-13 10:58:20
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Geriatric Examination Intervention
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NM1
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NM1
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  1. Causes of Falls
    Intrinsic: LE weakness, poor grip strength, balance disorders, functional/cognitive impairments, visual deficit

    Extrinsic: polypharmacy (at least 4 prescriptive meds)

    Environmental: poor lighting, rugs/carpets, lack of safety equipment in bathroom
  2. Potentially Inappropriate Med Use in Adults
    • Anticonvulsants (peripheral neuropathy)¬†
    • Antipsychotics (drowsiness, movement disorders (dyskinesia))
    • Benzodiazepines ("pam") (drowsiness)
    • Hypnotics
    • Antidepressants
  3. Common Fall Risk Factors
    • Muscle weakness¬†
    • Gait deficits
    • Assistive device
    • Arthritis
    • Depression
    • Age > 80
    • Hx of falls
    • Balance deficits
    • Visual deficits
    • Impaired ADL
    • Cognitive impairment
  4. Tests and Measures: Body Structure & Function
    • Geriatric Depression Scale:
    • Self-rated questionnaire¬†
    • 0-5 = normal
    • >5 = suggests depression (follow up suggested)
    • >10 = almost always depression (follow up recommended)

    • Patient Health Questionnaire-2:
    • Depression screening
  5. Tests and Measures: Activities
    • Dynamic Gait Index:
    • 8 tasks
    • 0-3 scale
    • Tested w/ assistive device
    • <19 = increased fall risk

    • Gait Velocity:
    • timed gait task
    • <.56 m/s = increased fall risk

    • Activities-Specific Balance Confidence Scale (ABC):
    • Self-report of confidence while performing 16 activities
    • <67% = increased fall risk
  6. Tests and Measures: Participation
    • Life Satisfaction Questionnaire-9:
    • Addresses overall life satisfaction (score 1-6)
    • Less than or equal to 4 = dissatisfied
  7. Signs of Elder Abuse
    Physical abuse: neglect or mistreatment, bruises, pressure marks, broken bones, abrasions, burns

    Emotional abuse: unexplained withdrawal from normal activities, sudden change in alertness, unusual depression, strained/tense relationships, frequent argument between caregiver and pt

    Financial abuse: sudden changes in financial situation

    Neglect: bedsores, unattended medical needs, poor hygiene, unusual weight loss

    Verbal/emotional abuse: belittling, threats or use of power/control
  8. Elder Abuse: Risk Assessment Measures
    • Hwalek Sengstock Elder Abuse Screening (HS/East): violation of personal rights, vulnerability, potential abuse
    • American Medical Association (AMA) Screen for Abuse/Neglect
    • Partner Violence Screen

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