GERIATRIC ASSESSMENT UNIT

When older adults experience changes in their thinking or judgment, their ability to care for their personal or household needs, finances, or physical health, the whole person is negatively changed. Geriatric assessment units (GAUs) can respond with a perspective from the specialty of aging when one or more of these major areas declines. Most GAUs can provide services for older adults in response to at least one of the following three scenarios: (1) when there are multiple medical problems or changes in ability to live independently; (2) because of changes in a variety of age-related areas the older adult would benefit from seeing a variety of specialists who focus on aging; and (3) when an older adult requires a focused evaluation and personal care plan.

GAUs cooperate with the patient's primary care physician to put the GAU's medical care plan into practice. GAUs also make referrals for services and follow-up with the older adult over time.

Generally, a concerned family member makes the GAU appointment. This concerned family member or another individual who knows the older adult well usually attends the appointment. A careful history and description of the present changes help to focus the appointment on the older adult's main problem. Older adults often come to the GAU because family members want to be certain that everything possible is being done to help their older family member live comfortably. The reasons for a GAU appointment may also include questions regarding the older adult's diagnosis, memory loss, depression, and decline in their ability to care for themselves; questions if the older adult needs in-home services or relocation into an assisted living or nursing home setting; confusion regarding multiple medical problems; behavior changes; worries about different effects of taking many medications; and the family's need for education to work with these changes of aging. Increasingly, GAU services are requested to provide an opinion regarding the older adult's judgment and decision-making abilities in legal cases.

The GAU appointment is usually a new experience for older adults and their family members. Most people have experienced short medical evaluations at some point during their lives. In contrast, the GAU often requires several hours or several long appointments to gather the information needed to gain a full picture of the older adult's situation. The GAU generally uses an interdisciplinary team of professionals from different training background. This team usually includes a nurse, social worker, and physician who are specifically trained in working with older adults. The appointment and the interdisciplinary team are costly. These special features of the GAU threaten its very future because policy makers, Medicare, Medicaid, and private insurance companies often fail to recognize the long-term benefit of these services.

The GAU appointment is generally divided into two parts. The medical team meets privately with the family to learn about their concerns, past medical history, and the older adult's ability to care for himself in his present living situation. At the same time, the nurse or social worker meets with the older adult to obtain his or her perception of how the older adult is feeling or getting along at home. In addition, short memory tests and questions regarding mental health issues may be reviewed with the older adult. Next, the interdisciplinary team introduces the physician, who conducts a physical examination. During this time family members receive from the nurse or social worker the testing results that provide appreciated education and explanations for the changes in thinking or behavior by the older adult. Suggestions for providing a safe environment for the older adult are reviewed. These discussions often lead to suggested compromises in both the family's and the older adult's routine. Family members are encouraged to make personal notes of service referral information and a diary of the changes seen in their older family member. The nurse or social worker may also review a family tree to explore additional available sources of personal care and support for the older adult, the health of the patient's family members, or causes of death among family members. GAU appointments generally conclude with a family conference that included the professional team's review of what was learned and recommended for the older adult. Referrals to additional specialists in physical therapy, occupational therapy, nutrition, ministry, pharmacy, as well as community resources are made to meet the different needs of the older adult. Every effort is made to involve the older adult in any suggested plans.

Special geriatric assessment unit locations

Outpatient clinic. Community-based outpatient clinics often provide easy access for older adults. Services such as X-ray and laboratory testing are readily available. It appears that some older adults try harder on memory testing in a clinic-type setting.

Inpatient hospital. Being assessed while hospitalized makes it more difficult for patients to perform at their best since they are already ill. However, all medical services, including laboratory testing and relevant professionals, are available to help make a diagnosis.

Senior housing communities. Providing a GAU within a housing community for older adults provides a comfortable relaxed environment and eliminates transportation problems. The professional team often coordinates easily with home health care services and is aware of the older adult's home environment and thus can better recommend needed in-home care services.

In summary, GAUs review with focused consideration the older adult's entire health and living situation. Mental health professionals are then able to plan a course of action with the older adult, the family, and primary care doctors, insuring the best possible health, continued independence and, hopefully, avoidance of health crises.

Irene Moore

See also Assessment; Multidisciplinary Team.

BIBLIOGRAPHY

Agency for Health Care Policy and Research. Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias: Clinical Practice Guidelines. Rockville, Md.: U.S. Department of Health and Human Services, November, 1996. AHCPR Publication 97–0702. Page 72.

Gallo, J. J.; Fulmer, T. ; Paveza, G. J.; et al., eds. Handbook of Geriatric Assessment, 3d ed. Gaithersburg, Md.: Aspen, 2000.

Greganti, M. A., and Hanson, L. C. "Comprehensive Geriatric Assessment: Where Do We Go From Here?" Archives of Internal Medicine 158 (1996): 15–17.

Gwyther, L. P. "When 'The Family' Is Not One Voice: Conflict In Caregiving Families." Journal of Case Management 4 (1995): 150–155.

Weuve, J. L.; Boult, C.; Morishita, L. "The Effects of Outpatient Geriatric Evaluation and Management on Caregiver Burden." The Gerontologist no. 4 (2000): 429–436.

GERIATRIC EVALUATION AND MANAGEMENT

See Geriatric assessment unit; Geriatric medicine