Geriatric Assessment Tests

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Geriatric Assessment Tests

Definition

Geriatric assessment tests are used to evaluate an older person's physical health, functional ability, cognitive and mental health, and social health and quality of life.

Purpose

The purpose of geriatric assessment tests is to generate information for the health care provider for diagnosis, prognosis, plan of care, current health status, and at-risk status of older patients/clients. One approach is for health care providers to rapidly screen several areas by asking screening questions related to various areas of health and function. Answers to screening questions should be based on the older person's day-to-day activities.

Precautions

There are no specific precautions associated with geriatric assessment tests. Health care professionals administering the tests should have a complete medical history of the patient before beginning the tests.

Description

Health care for older adults focuses on function, which covers the physical, cognitive-mental (thinking and remembering), psychological, and social aspects of a person's life. "Quality of life" is a term that is often used as a single, general measurement of the combination of all these functional aspects of life. Each aspect of function should be evaluated routinely in all sites of care, such as the doctor's office, the hospital, an assisted-living facility, or the home. These evaluations are called geriatric assessment tests.

Assessment of physical functions

Functional status refers to the tasks a person can perform in daily life. These tasks are usually referred to as "activities of daily living" (ADLs). These self-care tasks include bathing, eating, dressing, and using the toilet, and are especially important because they are the basic ADLs considered essential for independent living. Health care providers usually ask whether the person requires the help from someone else to complete these basic tasks. They will also ask about the person's ability to manage household affairs, such as using the telephone, stove, or washer. These are called instrumental ADLs.

Healthcare professionals can often learn a lot about functional status by simply watching their older patients complete various tasks. Examples include unbuttoning and buttoning a shirt or blouse, picking up a pen and writing a sentence, removing and putting on shoes, touching the back of the head with both hands, and getting on and off an examination table. Their healthcare provider may use a term called "body mass index" or BMI. A person's BMI is their weight in kilograms (kg) divided by the square of their height in meters. A BMI of less than 20 kg per meter squared or an unintentional weight loss of more than ten pounds suggests poor nutrition, which should be investigated promptly.

Assessment of cognitive and mental health

The number of people who have problems related to thinking or remembering doubles every five years after age 65. By age 90, about half of us have problems with some mental functions. Even in the absence of diagnosed dementia, older adults with some mental difficulties are at increased risk of accidents, delirium, missed medication and doctor appointments, and disability. It is important to be aware that most people with these problems do not complain of memory loss or symptoms of lessened mental abilities, even when specifically questioned. Healthcare providers often ask simple questions to screen for mental problems during office visits with older adults, especially those 75 years old and older

Memory loss is typically the first sign of dementia. The best single screening test for memory is to try and remember three words after one minute. Anything other than perfect recall means that further testing should be done. The most commonly used formal test is the Folstein Mini-Mental State Examination (MMSE), which assesses word recall, attention, and calculation, language, and visual-spatial skills.

An often overlooked area of thinking is "executive function." This refers to the ability to be flexible (changing behavior in a changing situation), understand new intentions, or plan actions. A useful question to evaluate executive function is asking a person to name as many four-legged animals as possible in one minute. Listing fewer than eight to ten animals or repeating the names of the same animals is abnormal and suggests the need for further evaluation. The "clock-drawing test" also evaluates executive function, as well as visual-spatial skills. In the clock-drawing test, the person is asked to draw the face of a clock and to place the hands correctly to indicate 2:50 or 11:10.

A large number of older adults suffer from some symptoms of depression. Anxiety and worries are important symptoms in older people that often suggest an underlying depression. In addition, older adults are particularly likely to experience the loss of a loved one, resulting in grief that can lead to depression. People showing symptoms of depression are at increased risk of physical disability. They also recover more slowly after an event that causes disability, such as a broken bone. Symptoms of depression should be treated as soon as possible. One question a healthcare provider and ask is, "Do you often feel sad or depressed?" A "yes" response means that the possibility of depression should be further evaluated.

Assessments of social health and life quality functions

A social assessment should address numerous areas, including the following:

The availability of family and friends to provide personal support
The need for a caregiver (and what type of help the caregiver routinely provides)
The general financial situation of the older person
The possibility of elder mistreatment or abuse, either physical or mental
Advance directives of the older person

During the past decade, the term quality of life has been used as sort of a catch-all phrase to describe overall health and well-being beyond traditional measures of disease. Quality of life includes various aspects of physical, mental, psychological, and social function. It can mean different things to different people. For example, pain management may be most important to some people, while mobility is the main goal for others. Older adults should discuss their expectations and wishes with their healthcare providers, family, and caregivers.

ASSESSMENT OF DRIVING ABILITIES. Evaluating the older driver is difficult for both healthcare providers and families of older adults. Cars are the most important, and often the only, source of transportation for older people. Yet, a variety of age-related changes, chronic conditions, and medications may place older adults at risk of car accidents. The absolute number of crashes involving older drivers is low, because older drivers spend less time behind the wheel than younger drivers. However, the number of crashes per mile driven and the chance of serious injury or death during a crash is higher for drivers over 65 years old than for any age group except drivers 16-24 years old. To their credit, most older people adjust their driving behaviors and habits. Risk can be reduced by avoiding rush-hour traffic, busy or congested streets, night driving, and driving during bad weather. Regardless, impaired drivers who stay on the road are a safety hazard to themselves and to other drivers, passengers, and pedestrians. Unfortunately, many older drivers are not aware of their driving limitations.

Any report of an accident or moving violation should trigger an evaluation of the driving ability of an older adult. In fact, physicians in many states are encouraged, if not required, to report their concerns to the department of motor vehicles. Healthcare providers and family members need to discuss safety concerns honestly with each other and with the older driver. Alternative methods of transportation should be considered, such as public transportation services or services provided by non-profit organizations. However, recommendations to stop driving should not be made lightly, because a sudden loss of driving privileges can lead to decreased activity and increased symptoms of depression in older adults. Referral for a formal driving evaluation by a skilled occupational therapist may be helpful in confirming unsafe driving behaviors and possibly in suggesting specialized equipment to correct for certain physical disabilities.

Preparation

No special preparation is required for geriatric assessment tests.

Aftercare

There is no aftercare required as a direct result of the tests. However, follow-up care may be needed in specific areas in which deficiencies are found based on the tests. For example the physical test may show the older person is in relatively good health for his or her age but the mental health tests may discover the person is depressed. An appropriate response would be to refer the older person to a mental health care professional (psychiatrist, psychologist, or counselor) for further evaluation and treatment.

Complications

There are no complications associated with geriatric assessment tests.

Results

Results will vary from test to test but all should indicate areas where the older person's functions and abilities are with scientifically established normal parameters, They should also indicate areas where there are problems or deficiencies or at-risk status. When testing indicates a particular problem, the issue should be addressed by the primary care physician or referred to a specialist in that field. For example, if the tests indicate the older adult has vision and hearing problems, he or she should be referred to a vision specialist (optometrist or ophthalmologist) and a hearing specialist (otorhinolaryngologist, audiologist, or speech and language pathologist) for further evaluation

Health care team roles

Geriatric nurse

Geriatric nurses function as practitioners, educators, case managers, consultants, researchers, and administrators and are critical to the ongoing clinical management of caseloads of patients, as well as a variety of organizational, administrative, and leadership services. Geriatric nurses play a crucial role in providing health care to the older adult population. Trained with specialized skills for elderly patients, geriatric nurses focus on both acute and chronic care, customized health education programs, and support and counsel for the families of elderly patients. Geriatric care nurses are often considered surrogate family because they are the primary caregivers, and the length of this nurse-patient relationship is often long-term

KEY TERMS

Activities of daily living— Self-care tasks include bathing, eating, dressing, and using the toilet, considered essential for independent living.

Body mass index— A person's weight in kilograms (kg) divided by the square of their height in meters.

Cognitive— Relating to the process of acquiring knowledge by using reasoning, intuition, and perception.

Executive function— The ability to be flexible (changing behavior in a changing situation), understand new intentions, or plan actions.

Otorhinolaryngologist— A physician who specializes in diseases of the ear, nose, and throat.

Geriatric nurse practitioner

Geriatric Nurse Practitioners (GNPs) typically provide primary heath care services along with sophisticated management of complex acute and chronic illness to older people. GNPs skills include identification, screening, and triage of acute episodic illnesses, nursing and medical management of commonly encountered acute and chronic illnesses in collaboration and consultation with an interdisciplinary geriatric team. They also develop a knowledge base of community needs and resources available for health promotion in older persons. GNPs also do health teaching, guidance, and counseling of geriatric clients and their families about illnesses common to the elderly and their prevention, health promotion, maintenance, and management. They provide medication intervention and education for older persons and initiate and perform diagnostic tests.

Geriatric dietician

Geriatric dieticians play leadership roles in improving the quality of life of older persons by providing competent clinical geriatric dietetic services. They are responsible for integrating diet selections with basic institutional menus, applying nutritional assessments and therapeutic diets as they relate to geriatric care, and act as liaisons with medical, nursing and other healthcare professionals regarding their older patients' food habits and nutritional well being. They often instruct community residents and patients and their families concerning nutritional requirements, clinical diet regimes and food planning and preparation.

Resources

BOOKS

Attix, Deborah K., and Kathleen A. Welsh-Bohmer. Geriatric Neuropsychology: Assessment and Intervention. New York: The Guilford Press, 2005.

Cotter, Valerie, and Neville E. Strumpf. Advance Practice Geriatrics Nursing. New York: McGraw-Hill Medical, 2001.

Gallo, Joseph J., et al. Handbook of Geriatric Assessment. Sudbury, MA: Jones & Bartlett Publishers, 2005.

Norman, Robert A., and T.S. Dharmarajan. Clinical Geriatrics. London: Taylor & Francis Group, 2002.

PERIODICALS

Danter, Joyce Harter. "Geriatric Assessment." Nursing (December 2003): 52-55.

Dellasega, Cheryl A., et al. "The Impact of a Geriatric Assessment Team on Patient Problems and Outcomes." MedSurg Nursing (August 2001): 202.

Murphy, Dale P., and Catherine Maxwell. "Elderly Drivers: When Is It Time to Take the Keys Away?" Consultant (January 2005): 18-22.

Murphy, Dale P., and Maryjo Cleveland. "A Systematic—And Realistic—Approach to Functional Assessment of Elderly Persons." Consultant (January 2004): 47-49.

Musson, Judith B. Rappaport. "Comprehensive Geriatric Assessment: Assuring Appropriate Treatment and Improving Quality of Life." Elder's Advisor (Winter 2003): 1-10.

VanSwearingen, Jessie M. "Making Geriatric Assessment Work: Selecting Useful Measures." Physical Therapy (June 2001): 1233.

ORGANIZATIONS

American Geriatrics Society. Empire State Building, 350 Fifth Avenue, Suite 801, New York, NY 10118. (212) 308-1414; Fax: (212) 832-8646; Email: [email protected]. 〈www.americangeriatrics.org〉.

National Gerentological Nursing Association. 7794 Grow Drive, Pensacola, FL 32514. (800) 723-0560; Fax: (850) 484-8762; Email: [email protected]. 〈www.ngna.org〉.