Academic Geriatric Resource Center
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AT A GLANCE

Glossary

0. Introduction
1. Demography And Epidemiology
1.1 The Changing Face of Aging: Objectives
1.2 Local and Regional Variations Among Older Adults in the United States
1.3 Implications of an Aging Society for Health Care Needs and Resources
1.4 Common Chronic Conditions Associated with Advanced Age
1.5 Post Test
2. Biology and Physiology of Aging
2.1 Introduction and Background
2.2 Theories of Aging
2.3 Physiological Changes with Aging
2.3.1 Loss of Homeostatic Reserve--Hyperthermia
2.3.2 Loss of Homeostatic Reserve--Hypothermia
2.3.3 Vulnerability of Older Adults to Hypothermia
2.3.4 Clinical Importance of Vulnerability to Hypothermia
2.3.5 Loss of Homeostatic Reserve--Other Examples and Clinical Implications
2.3.6 Clinically Important Age-Related Changes in Organ Systems
2.3.7 Clinically Important Age-Related Changes in the Renal System
2.3.8 Clinical Significance of Age-Related Changes in Renal System
2.3.9 Clinically Important Age-Related Changes in the Cardiovascular System
2.3.10 Clinical Significance of Age-Related Changes in the Cardiovascular System
2.3.11 Clinically Important Age-Related Changes in the Pulmonary System
2.3.12 Clinical Significance of Age-Related Changes in the Pulmonary System
2.3.13 Age-Related Changes in the Neurologic System
2.3.14 Clinical Significance of Age-Related Changes in the Neurologic System (I)
2.3.15 Clinical Significance of Age-Related Changes in the Neurologic System (II)
2.3.16 Clinically Important Age-Related Changes in the Gastrointestinal System
2.3.17 Clinical Significance of Age-Related Changes in the Gastrointestinal System (I)
2.3.18 Clinical Significance of Age-Related Changes in the Gastrointestinal System (II)
2.3.19 Clinically Important Age-Related Changes in the Immune System
2.3.20 Clinical Significance of Age-Related Changes in the Immune System
2.3.21 Clinically Important Age-Related Changes in the Endocrine System (I)
2.3.22 Clinically Important Age-Related Changes in the Endocrine System (II)
2.3.23 Clinical Significance of Age-Related Changes in the Endocrine System
2.3.24 Clinically Important Age-Related Changes in the Musculoskeletal System
2.3.25 Clinical Significance of Age-Related Changes in the Musculoskeletal System (I)
2.3.26 Clinical Significance of Age-Related Changes in the Musculoskeletal System (II)
2.3.27 Clinically Important Age-Related Changes in the Genitourinary System (I)
2.3.28 Clinically Important Age-Related Changes in the Genitourinary System (II)
2.3.29 Clinical Significance of Age-Related Changes in the Genitourinary System
2.3.30 Clinically Important Age-Related Changes in the Sensory Systems
2.3.31 Clinical Significance of Age-Related Changes in the Sensory Systems (I)
2.3.32 Clinical Significance of Age-Related Changes in the Sensory Systems (II)
2.3.33 Clinically Important Age-Related Changes in the Integument
2.3.34 Clinical Significance of Age-Related Changes in the Integument
2.4 Pharmacologic Considerations
2.5 Post Test
3. Socio-cultural And Psychologicial…
3.1 Module Objectives
3.2 Social Theories of Aging
3.3 Psychological Development In Late Life
3.4 Ethno-Cultural Issues And Age-Stratified Societies
3.5 Late-Life Transitions
3.6 Dependent Elders: Special Concerns
3.7 Cultural Views of Death
3.8 References
3.9 Post Test
4. Assessment Of The Geriatric…
4.1 Module Objectives
4.2 Domains of Assessment: Functional Assessment
4.2.1 How to Use Information from a Functional Assessment
4.2.2 Vision Impairment
4.2.3 Hearing Impairment (I)
4.2.4 Hearing Impairment (II)
4.2.5 Oral and Dental Health
4.2.6 Introduction to Oral Health Assessment
4.2.7 Oral Health Assessment
4.2.8 Common Oral Conditions in Older Adults: Tooth Loss (I)
4.2.9 Common Oral Conditions in Older Adults: Tooth Loss (II)
4.2.10 Common Oral Conditions in Older Adults: Care of Dentures
4.2.11 Common Oral Conditions in Older Adults: Dental Decay
4.2.12 Common Oral Conditions in Older Adults: Periodontal Disease
4.2.13 Common Oral Conditions in Older Adults: Candidiasis Infection
4.2.14 Common Oral Conditions in Older Adults: Leukoplakia and the Risk for Oral Cancer
4.2.15 Guidelines for a Dental Referral
4.2.16 Falls and Gait Assessment
4.2.17 Assessing for Falls
4.2.18 Techniques for Gait Assessment
4.2.19 Gait Assessments and Falls Interventions
4.2.20 Risk Factors for Falls and Targeted Interventions
4.2.21 Modification of Risk Factors: Ability to Get Up After a Fall
4.2.22 Modification of Risk Factors: Fracture Risk
4.2.23 Modification of Risk Factors: Anticoagulation
4.2.24 Incontinence
4.2.25 Skin Breakdown: Pressure Ulcers
4.2.26 Cognition/Dementia
4.2.27 Benefits of Early Detection of Dementia
4.2.28 Screening Techniques for Dementia
4.2.29 Decision-Making about Dementia Screening
4.2.30 Nutrition
4.2.31 Alcohol Use and Alcoholism
4.2.32 Medication and Complementary Therapies
4.2.33 Case Example: Mr. Singh
4.2.34 Mr. Singh--Use of Herbal Medicines
4.2.35 Mr. Singh--Possible Interventions
4.2.36 Mr. Singh--Concerns about Marathon Running at 92?
4.2.37 Mr. Singh--Considerations for Patient/Family Well-Being
4.2.38 Assessing for Polypharmacy (I)
4.2.39 Assessing for Polypharmacy (II)
4.3 Domains Of Assessment: Psychosocial Health And Functioning
4.4 Special Considerations In Assessment
4.5 Post Test
5. Health Care Policies
5.1 Module Objectives
5.2 The Policy-Making Process
5.3 Financing Health & Long Term Care
5.4 Quality Of Care Issues In Long Term Care
5.5 Need And Access Across The Spectrum Of Care
5.6 References
5.7 Post Test
6. Exploring Age-Related Body…
6.1 Cardiovascular System
6.2 Endocrine System
6.3 Immune System
6.4 Musculo-Skeletal System
6.5 Neurological System
6.6 Renal System
6.7 Post Test

Module 4: Assessment Of The Geriatric Patient

4.1: Module Objectives


Upon completion of this module, participants will be able to:

  1. Describe the key elements of a general geriatric assessment instrument and the rationale for the use of such an instrument.
  2. Identify three factors that make the care of older people different from the care of younger people.
  3. List three time-saving strategies that can be used when caring for older patients in an ambulatory setting.
  4. List at least one assessment instrument for each of the following and describe it briefly:
    1. Dementia
    2. Depression
    3. Falls and mobility disorders
    4. Pressure ulcers
    5. Sensory impairment: hearing/vision
    6. Gait
    7. Caregiver strain/stress
    8. Elder abuse
    9. The home
  5. Describe at least one non-pathologic and one pathologic finding that is associated with aging in the following physical exam areas:
    1. General appearance
    2. Skin
    3. Eyes
    4. Mouth and teeth
    5. Cardiovascular
    6. Genitourinary
    7. Neurologic

     

4.2: Domains of Assessment: Functional Assessment


Functional impairment is common among older adults, especially in those over the age of 85. Approximately half of adults over the age of 85 have impairments in their IADLs (transportation, shopping, cooking, using the telephone, managing money, taking medications, cleaning, laundry) or ADLs (bathing, dressing, eating, transferring, continence, toileting) (Guralnik, Fried, & Salive, 1996).

Functional information should be included in the assessment of all older people.

Health care providers should be aware that many functionally impaired people tend to overestimate their functional abilities, while caregivers tend to slightly underestimate the patient’s abilities. Direct observation is the most accurate method of functional assessment, but is impractical in most health care settings (Katz, Ford, Moskowitz, Jackson, & Jaffee, 1963; Reuben, Valle, Hays, & Sui, 1995; Sinoff & Ore, 1997; Zanetti, Geroldi, Frisoni, Bianchetti, & Trabucchi, 1999). Averaging the information between patient and caregiver or simply being aware of the limitations of reported data is sufficient for most health care providers.

4.3: Domains Of Assessment: Psychosocial Health And Functioning


Psychosocial Health and Functioning: Depression

Depression is commonly missed in primary care. Although major depression is no more common in the elderly than in younger populations, depressive symptomatology is actually more common. In ill and hospitalized elders, the prevalence of depression is quite high. A simple two-question screen has high sensitivity (96%) for detecting depression in a general population. Positive responses can be followed up with more comprehensive interviews, since the specificity of a positive response is not high (Cobbs et al., 1999; Whooley, Avins, Miranda, & Browner, 1997). The Geriatric Depression Scale has been validated in both a 15 item and a 30 item form (Sheikh & Yesavage, 1986; Yesavage, 1988).

Depression Assessment Tools:

Whooley Two-Item Depression Screen

Geriatric Depression Scale (Short Form)

(NOTE: These links will open in new browser windows which you can close to return here. They are to PDF documents, which require the free Adobe Acrobat Reader software.)

4.4: Special Considerations In Assessment


Screening in the High-Functioning Elder: Advanced Activities of Daily Living

For highly functional independent elders, standard functional screening measures will not be useful in capturing subtle functional impairments. Two techniques may be useful for these elders. The first is to identify and regularly query about a target activity, such as playing bridge or golf, fishing, or practicing law, that the patient enjoys and regularly participates in. The term “advanced activity of daily living” (AADL) has been used to describe this type of activity. If the patient begins to drop the activity, it may indicate an early impairment, such as dementia, incontinence, or worsening hearing loss. Of course, significant limitations in this approach exist, as the implications of dropping golf versus dropping a law practice are quite different. However, many health care professionals find this type of marker extremely helpful for following patient functioning.

Module 4: Assessment Of The Geriatric Patient
3.9 Post Test
4.1 Module Objectives