HEALTH ASSESSMENT OF GERIATRIC POPULATION

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to

evaluate and older persons

 functional ability
 physical health
 cognition and mental health and
 socio environmental circumstances.

It is usually initiated when a nurse identifies a potential problem. Specific elements of physical
health that are evaluated includes -

 nutrition vision hearing fecal and urinary incontinence and

 balance geriatric assessment aids in the diagnosis of medical conditions,
 development of treatment and follow up plans,
 co-ordination of management of care,
 evaluation of long term care needs optimum placement.

comprehensive geriatric assessment diagram hey (draw the diagram)

Definition : hey the geriatric assessment is a multidimensional, multi disciplinary assessment

Designs to evaluate an older persons functional ability physical cognition and mental health and
socio environmental circumstances. It includes an extensive review of prescription and over the
counter drugs, beta means and herbal products as well as a review of immunisation status.

Geriatric assessment

1. functional ability :

functional status refers to a person's ability to perform tasks that are required for leaving. The
geriatric assessment begins with a review of 2 key divisions of functional ability

A. activities of daily living (ADL)

B. instrumental activities of daily living (IADL)

a. Activities of daily living (ADL): activities of daily living are self care activities that a
person performs daily. example eating, dressing, bathing, transferring between bed and
chair using the toilet controlling bladder and bowel functions etc.
b. Instrumental activities of daily living: these are activities that are needed to live in
dependently. example doing housework, preparing meals, taking medications properly,
managing finances, using telephone etc.

These 2 assessment are needed for more in depth evaluation of the patients’ socio-
environmental circumstances and the need for additional assistance .
2. Physical health : the assessment in corporates all the information:
 convention medical history, including main problem
 current illness
 past and current medical problems
 family and social history
 demographic data and
 review of system.
The approach to the history and the physical examination, however, should be specific
to older persons.

3. Screening for diseases: In the normal aging process, there is often a decline in
physiological function that is usually not disease related. However, treatment of
diabetes mellitus, hypertension and glaucoma can prevent significant future morbidity.
Screening for malignancies may allow for early detection and some are curable if treated
early. It is important that nurse weigh the potential harms of screening before screening
older patients. It is essential to consider family preferences regarding treatment if a
disease is detected and patient’s functional status, comorbid conditions, and predicted
life expectancy.

4. Nutritional assessment: Nutritional assessment is important because inadequate

micronutrient intake is common in older persons. Several age-related medical
conditions may predispose patience to vitamin and mineral deficiencies VITAMIN A, C, D
and B 12, calcium, and other trace minerals are often deficient in older population. Even
in the absence of conditions such as pernicious anaemia or malabsorption. There are 4
components specific to geriatric nutritional assessment:
o nutritional history performed with nutritional health checklist
o a record of patient’s usual food intake based on 24-hour dietary recall
o physical examination with particular attention to signs associated with
inadequate nutrition or overconsumption and
o select laboratory test if applicable

5. Vision: The most common causes of vision impairment in older persons include
presbyopia, glaucoma, diabetic retinopathy, cataracts and age-related macular
degeneration. Hey there food periodic health examination is advised hey by using a
snellen chart to screen for visual acuity and recommended that older patients who have
had diabetes for at least 5 years have assessment by an ophthalmologist every year.
6. Hearing: Press by qc's is the 3rd most common chronic condition in older adults after
hypertension and arthritis. So, audio scope examination, auto scope examination and the
whispered voice test are recommended for older adults.
Additionally, patient medication should be examined for potentially ototoxic drugs.
Patient with chronic otitis media or sudden hearing loss or who fail any screening test
should be referred to and otolaryngologist.

7. Urinary incontinence: Urinary incontinence, the unintentional leakage of urine affects

approximately 15 million people in the United States, most of whom are older. Urinary
incontinence has important medical repercussions and is associated with decubitus
ulcer, sepsis, renal failure, urinary tract infection and increase mortality. Psychological
implications of incontinence include loss of self-esteem, restriction of social and sexual
activities and depression.
And assessment for urinary incontinence include:
 the evaluation of fluid intake
 medications
 cognitive function
 mobility and
 previous urological surgery.
8. Balance & fall prevention: Impaired balance in older persons often manifest as false and
fall-related injuries. Approximately 1/3 of community-living older persons fall at least
once per year & many falling multiple times. Falls are the leading cause of
hospitalization and injury related death in Persons 75 years and older.

The Tinetti Balance and Gait Evaluation is a useful tool to assess our patient’s fall risk.
This test involves observing as:
 a patient gets off from a chair without using his or her arms
 walks 10 feet
 turns around
 walks back and
 returns to a seated position.
This entire process take less than 16 seconds. Those patients who have difficulty
performing this test have an increased risk of falling and need further evaluation.
 9. Osteoporosis: Osteoporosis may result in low-impact or spontaneous fragility fractures
which can lead to a fall, can be diagnosed clinically or radiographically.
10. Polypharmacy: Polypharmacy, which is the use of multiple medications or the
administration of more medications than clinically indicated, is common in older
persons or older adults. 30% of hospital admissions and many preventable problems
such as false and confusion, are believed to be related to the adverse effect of the drug.
So an older patient’s medication assessment is needed to reduce the adverse effects.
11. Cognition & Mental Health Assessment:
a. DEPRESSION: Depression is very common in older adults. So, to assess
depression, Geriatric Depression Scale and the Hamilton Depression Scale
are the easiest to use and most widely accepted.
b. DEMENTIA: Early diagnosis of dementia allows patient's timely access to
medications and help families to make preparations for the future. It can also
help in the management of other symptoms that often accompany the early
stages of dementia, such as depression and irritability. There are several
screening tests available to assess cognitive dysfunction. However, the Mini
Cognitive Assessment Instrument is the preferred test.
c. SOCIO-ENVIRONMENTAL CIRCUMSTANCES: Determining the most suitable
living arrangements for older patients is an important function of the
geriatric assessment. Factors affecting the patients socio environmental
circumstances include their social interaction network , available support
resources special needs and environmental safety.

Problem list

As assessment data are obtained, they need to be recorded to allow all members of the
healthcare team to easily access the information. The nurse can generate a problem list that
includes any conditions or events requiring new or ongoing care, the medical, nutritional,
functional and social implications and proposed intervention. This type of assessment allows
older patients to benefit from an interdisciplinary team that is effectively as I saying and
actively managing their healthcare.