Geriatric assessment

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• Geriatric assessment
• is the heart and soul of geriatrics

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Series of contrasts

• 1) caring and curing,
• 2) disease and functional status,
• 3) diagnosis-and-treat medicine and management of
  multiple diseases,
• 4) between medicine acting competently alone and
  as part of interdisciplinary effort

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• ???????????? comprehensive geriatric assessment
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• ???????????????????????????????????
  ?????????????????????????????, ???????????????????
  ?????

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??????.1980s ????????????????????????????????????
?? CGA

• ????????????????????????
• ??????
• ????????????????? ???
• ????????????????? ?
• ????????????? Laurence Rubenstein
• ????????? CGA - medical lexicon

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??????. 1987 (3 ??????????????????) NIH
??????????????

• ??????????? CGA
• ????????/????????????
• ?????????????????????
• ???????????????????????? ?????????
• ??????????????????????????????????????????????????
  ????????????????????????, ??????
  ???????????????????
• multidisciplinary evaluation

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??????. 1981 - White House Conference on Aging

• ?????????????????????????????????
• ??? CGA ???????????????? ??????????????????,
  ?????????, ??????? ??????????????????????
• ????????/??????????????????????????
  ????????????????????????? ???????????????????????
  , ????????????????, ?????? ??????????
  ??????????????, ??????? ??????? ?

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Comprehensive Geriatric Assessment
multidimensional assessment

• To identify elders at high risk
• initial evaluation method
• develop programs combining rehabilitation or
  tertiary prevention and improved care
  coordination
• because of the complexity of the clinical
  presentations and needs. Special approach to
  their assessment and care

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??????????????????????????????????????
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• (???)
• ??????????????????????????????????????????????????
  ????? ????????????????????????????????????????????
  ?????????????
• ??????????????????????????????????
• (Elen et al,2000)

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• ?????? ????????? ?????????????????????
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Interdisciplinary Team Concept CGA

• Health status
• Physical capacity
• Cognitive ability
• Mood behavior
• Social support, and
• The environment

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Health Status and Physical Capacity

• Health - related quality of life
• self-report (the patient to have a voice)
• proxy - report
• observer - administered
• performance - based tests

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Health - related quality of life

• Provides supplemental information regarding the
  effects of illness or therapy on the function
  of the individual in the context of his/her
  environment

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Role function
Integration level III
Task or goal oriented function (ADL, IADL)
Integration level II
Specific physical movement-walk
Integration level I
Basic components
Role function fine motor
Balance
Strength
Flexibility
Endurance
A Hierarchical Model of Physical Function (NIA,
1993)
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Functional assessment

• The evaluation of a persons ability to carry out
  basic tasks for self care and tasks needed to
  support independent living. It is based on
  physical and psychosocial evaluation, with the
  assumption that any clinical condition can be
  diagnosed and properly treated.
• (Williams, 1995)

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Reasons of functional assessment

• Define the elders concerns
• May indicate a manifestation of disease
• Assist in determining a need for service (s)
• Assist in determining the type of placement
• Assist in determining cost/benefit of
  treatment/intervention

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Reasons of functional assessment

• (cont.)
• Assist in realistic goal setting
• Decrease fragmentation of care
• Assist in ethical/quality-of-life issues
• Help track untreated conditions (effects of
  arthritis)
• EBERSOLE . HESS (2001)

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Functional Assessment Tool

• BADL - is seen as tolal task\
• - Katz index
• - Barthel index
• IADL - independent living, more complex
  activities
• - in home - telephone, preparing meal, shopping,
  
• house work
• - outside - traveling
• - Medication, money
• AADL - ????????, ????????

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Level of Function

• Performance Oriented Mobility Assessment
• balance - ????, ????????????????, ????, ???????
• ????????? - ?????????????????????????
• ?????? ????? ????????????????, ???????????
• ???????

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Two - six - and twelve - minute walk tests - to
measures of maximum oxygen consumption
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• Performance - based vs self - report measures
  Goal -, task -, or role - oriented activities -
  highly individualized, cultural or social norms

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Mental Status Examination

• Arousal orientation -
• ????????????????????????????????? ??????????
  ??????? ??? ????
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• General behavior mood (????????????????)

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Mental Status Examination (???)

• Psychomotor speed activities
• ????
• ??????????????, ?????????????
• ????????
• Attention ????? ???????????? ??????????

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Mental Status Examination (???)

• Language - ????????? ?????????
• Memory
• short term
• recent
• remote information
• Perceptual skills and construction
• Praxis
• Computational skills

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????????????????????????

• MMSE (Mini Mental state Examination
• SPMSG (Short Portable Mental Status
  Questionnaire)
• Thai Mental Status Examination
• Geriatric Depression Scale (short version) GDS

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Social Support Networks

• Strong social ties - a buffering effect from
  stress
• reducing the vulnerability to stress related
  illness
• more equipped to manage the stress
• social isolation - vulnerability to morbidity
  mortality
• provide essential support - at time of illness
• can encourage an elder to observe health
  promoting behaviors and quit bad practices

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Social Networks
Social Supports

• Structural aspects
• web of social relationships

• functional aspects
• emotional or instrumental

Social supports are not the same as social
networks
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Assessing Social Support Networks

• ???????????
• ??????????????? (???????????)
• ??????????????? (confidant)
• ?????????????????????????? / ??????????

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Lubben Social Network Scale (LSNS)

• 1. ???????????????????????????????????????????????
  (?????????????????????)
• 2. ?????????????????????????????????????????????
• 3. ????????????????????????????????? ? ????????
• 4. ???????? / ????????????????????????????????????
  ??????????????? (?????????????????????) ?????

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Lubben Social Network Scale (LSNS)

• (???)
• 5. ???????? / ????????????????????????????????????
  
• 6. ???????? / ?????????????????????????????? ?
  ????????
• ????? 0 ????? 4 5-8
• 1 ?????
• 2 ??? 5 9 ?????????????
• 3 3 ???? 4
• (Lubben, 2000)

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RAND social support scale (SSS - A)

• How often do you have someone to love?
• How often does someone show love and affection to
  you?
• How often do you have someone to share worries?
• (Lubben, 2000)

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Multi dimensional Assessment in the Community

• Medical Assessment
• Visual impairment
• Hearing
• Mobility Balance
• Malnutrition
• Urinary incontinence
• Polypharmacy

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Multi dimensional Assessment in the Community
(cont.)

• Cognitive assessment
• Affective assessment
• Assessment of function (BADLs, IADLs, AADls)
• Social support
• Economic assessment
• Environment assessment
• Spirituality
• Advance directives