In short words, it is a complex interdisciplinary diagnostic which allows us to detect the physical, functional, psychological and social problems in the elderly in order to develop an intervention and long-term monitoringof problems. In addition to optimizing resources and getting a better independence.
But the global geriatric asssesment is really big so i am going to divide this point in five:
- Phisical assesment
- Funccional assesment
- Mental and social assesment
- Afective assesment
In my opinion is one of the most important because the patient's physical condition will determinate the activities that the pationt is going to be able to do. In addition the phisical problems are easier to treat than mental problems. I mean, heal an ulcer is easier to treat the alzheimer. Although this does not mean that the other reviews are not important.
A good clinical assessment must consist of:
Anamnesis which appear
- Personal history,
- Review of systems and symptoms, which leads us to the detection of large geriatric syndromes
- Complete drug history and update in order to detect possible symptoms and signs related to side effects
- Nutritional history
Physical examination: of course we can´t fully explore all patients but we can teach them about potential problems that could have and warn us that if it happens. Initial physical examination that if we do as nurses is to observe the physical, personal care, grooming .. and then take vital signs (temerperatura, blood pressure, heart rate and respiratory and oxygen saturation
Laboratory tests: which, although must send by the doctor, we need to know because if we suspect any disease, we should talk to the doctor in order toasks for the test. Some of them are: hemogram, glucose, electrocardiogram, mantoux thorax x.-ray...
Functional assessment
Is the process responsible for getting information about the ability of the elderly to perform their normal life. But How can we do that? Easy, we only have to use scales. But which is the best scale? well, depens what we want to review. For example, if we have to review how the elderly does the basic activities of daily living we can use:
- Katz Index of independence in activities of daily living
- Barthel Index
- Plutchik's Life Style Index
On the other hand, if we want to review how the elderly does the instrumental activities of daily living, we can use:
- Lawton and Brody Index
Mental and social assesment
Up till now i have talked about the "physical part" so now is turn to the psychological part which is very important too. I think that helping to treat these patients is the most complicated labor in which you must be really patience. I prefer to help in physical than in mental problems, although I know that both are important. Even if I thought for a moment I would say that the mental part is much more important than physical because what I prefer? -Having a bad appearance but have a good memory and ability to ration or having a good physical appearance but not even remember my name?
Returning to the mental and social assesment, we can divide this in two parts:
- Mental assesment: It is important to pay attention to the cognitive and affective parts, both parties are very fragile in the elderly.
However, while the elderly are cared for by the family, is still common to find elders with severe cognitive impairment whose family has never detected memory problems. Therefore, regardless of what tell the family and the patient, it is useful to make a small mental examination to reveal any problem at this level. In order to do this, we can turn to some index like: the Short Portable Mental Status Questionnaire of Pfiffer, Mini-mental State Examination of Folstein or cognitive mini-exam of lobo.
- Social assement: allows us to know the relationship between the old man and his environment. although it is a function of the social worker, the nurse should record all relevant data which affecting to the patient.
Afective assesment
In respect of affection, we can mention two psquiatric disorder very common which affect to elderly population are depression and anxiety.
- Depression: People over age 65 , depressions is a problem for as many as 1% to 9% of community-dwelling eldery, 10% to 26% or more of long-term care residents, and 11% to 46% of hospitalized older adults. But only 1 in 6 elderly who suffer forom depression is teated. Depression may be related to a wide range of factors, including loss of independence or loved ones or increased medical problem.
- Anxiety: is an emotional state of discomfort and aprhensión disproportionate to the stimulus that triggers it. In the elderly is more common as a symptom of anxiety as a disease and has repercussions on the life, cognitive performance and worsening depression
In order to appreciate the affective sphere, we can use a lot of scales but the most important is The Geriatric Depression Scale (Yesavage scale).
Bibliography
Bibliography
- Hoffmann G. Health Assessment of Older Adults. Basic Geriatric Nursing 5th Edition. Missouri: Elsevier; 2012. p 151-166.
- Redin J. Comprehensive geriatric assessment (I). Evaluation of the geriatric patient and the concept of fragility. Servicio de Geriatria del Hospital de Navarra [cited 10 de Apr 2013]. Available from: http://www.cfnavarra.es/salud/anales/textos/vol22/suple1/suple5.html
- Shelkey M, Mason V, Wallace M. Katz Index of Independence in Activities of Daily Living (ADL). The Hartford Institute for Geriatric Nursing. 2012 ; (2):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf
- Barthel D. Barthel Index. University of Dundee. 1999. Available from: http://www.dundee.ac.uk/medther/Stroke/Scales/barthel.htm
- Graf C. The Lawton Instrumental Activities of Daily Living (IADL) Scale. The Hartford Institute for Geriatric Nursing. 2013 ; (23):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_23.pdf
- Pfeiffer E. The short portable mental status questionnaire (SPMSQ). Standfor School of Medicine . 2010. Available from: http://geriatrics.stanford.edu/culturemed/overview/assessment/downloads/spmsq_tool.pdf
- Folstein M, Folstein S, McHugh P. Folstein Mini-Mental State Exam. utmb Health. 1975. Available from: http://www.utmb.edu/psychology/Folstein%20Mini.pdf
- Sherry A A. The Geriatric Depression Scale (GDS). The Hartford Institute for Geriatric Nursing. 2012 ; (4):1-2. Available from: http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf
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