GERIATRIC ASSESSMENT Jane Courtney family Community support nurses Speech therapist pharmacist dietician Multi-disciplinary team Multi-disciplinary team geriatrician physiotherapist Local doctor psychologist Occupational therapist World Health Organization definitions of disability. • Disease—an intrinsic pathology or disorder . . . [which] may or may not make [itself] evident clinically • Impairment—a loss or abnormality of structure or function at the organ system level • Disability—a restriction or lack of ability to perform an activity in a normal manner, a disturbance in the performance of daily tasks • Handicap—a disadvantage resulting from impairment or disability that limits or prevents fulfillment of a role that is normal PATHOLOGY (DISEASE) IMPAIRMENT (SYMPTOMS & SIGNS) DISABILITY (FUNCTIONAL LOSS) HANDICAP (SOCIAL CONSEQUENCES) DIAGNOSES Rheumatoid arthritis DISABILITIES Poor mobility Pain Poor hand function Carcinoma of prostate Incontinence TURP Hot flushes Radiotherapy Faecal urgency Hormonal therapy Pain Skeletal metastases ACTS OF DAILY LIVING (ADL’s) MOBILITY- independent with aid ( assist wheelchair bedbound ) TRANSFERS- independent assist not TOILET USE- independent assist not GROOMING- independent assist not SHOWERING- independent assist not DRESSING- independent assist not FEEDING- CONTINENCE- bladder bowels independent assist not COGNITION - MEMORY PROBLEM SOLVING SOCIALISATION BEHAVIOUR DOMESTIC FUNCTIONS- SHOPPING COOKING CLEANING TRANSPORT BARTHEL ADL index FUNCTIONAL INDEPENDENCE MEASURE (FIM) MINI MENTAL STATE EXAM MMSE (FOLSTEIN’s) GERIATRIC DEPRESSION SCALE (GDS) FIM (motor) Self-care A.Self-care B.Grooming C.Bathing D.Dressing upper body E.Dressing lower body F.Toileting Sphincter control G.Bladder management H.Bowel management Mobility (transfer) I.Bed, chair, wheelchair J.Toilet K.Tub, shower Locomotion L.Walk/wheelchair M.Stairs FIM(cognitive): Communication N.Comprehension O.Expression Social cognition P.Social integration Q.Problem solving R.Memory Score: 1 – 7 for each of 18 items (126) Independence: 7—complete independence (timely, safely) 6—modified independence (device used) Modified dependence: 5—supervision 4—minimal assistance (>75% of task) 3—moderate assistance (50%-74% of task) 2—maximal assistance (25%-49% of task) Complete dependence: 1—total assistance (subject performs <25% of task) MMSE 1 ORIENTATION- TIME (5) 2 ORIENTATION – PLACE (5) 3 REGISTRATION (3) 4 CALCULATION (5) 5 RECALL (3) 6 NAMING (2) 7 “NO IF ANDS OR BUTS” (1) 8 “3 STAGE COMMAND” (3) 9 “CLOSE YOUR EYES” (1) 10 WRITE A SENTENCE (1) 11 PENTAGONS (1) GERIATRIC DEPRESSION SCALE WHAT DO WE DO WITH THIS ASSESSMENT? PLAN CARE Rehabilitation is a problem solving and educational process aimed at reducing the disability and handicap experienced by someone as a result of a disease, always within the limitations of available resources. (ICIDH quoted in “oxford textbook of geriatrics”.) 1 assess- identify, analyze &measure problems 2 plan- analyze problem(s) & set goals 3 treat- intervene to reduce disability & handicap 4 care- intervene to alleviate consequences of disability 5 evaluate- check effectiveness AGED CARE ASSESSMENT TEAM (ACAT) ASSESS FOR APPROVAL OF GOVERNMENT FUNDING FOR CARE CO-LOCATED IN GERIATRIC DEPARTMENTS.