Comprehensive geriatric

assessment
Lota. Lua. Manalo. Manuel. Mangaser
MPGI

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

15 JULY 2022
 CASE 1
MAYAMAN FAMILY
Case 1: Mayaman family
Mayaman family: Mini mental status examination (mmse)
● Date, day, month, year- all wrong (0 pt)
● Season, hospital, floor, city, province, country- correct (5 pts)
● Registration – can repeat the words mango, table, coin (3 pts)
● Attention & calculation- spelling of the word “world” backwards-
ldrow (3 pts)
● Recall- cannotMini Mentalany
remember Status Examination
of the score:
words (mango, table, coin) (0 pt)
● Language 20 = Mild cognitive impairment
○ Can name objects (watch and pencil) (2 pts)
○ Can repeat phrase (1 pt)
○ Can follow 3-stage command (3 pts)
○ Can read (1 pt)
○ Can write sentence (1 pt)
● Drawing: correctly drawn (1 pt)
Mayaman family: GERIATRIC DEPRESSION SCALE (GDS)

Geriatric Depression Scale Short

Form Score: 6
Mild depression
KATZ INDEX OF DAILY LIVING
Bathing Toileting
No assistance Assistance in
going to
toilet/use of
commode or Katz Index of Daily
Continence cleansing self or Living Score: 4
Has occasional in arranging Moderate functional
accidents clothes impairment

Transfer
No assistance Dressing
(except No assistance
assistive device

Feeding
No assistance
Nutrition (mna screening - short form)

MNA SHORT FORM SCORE: 10

AT RISK OF MALNUTRITION
Case 1: Mayaman Family Preventive Measures- RM, 75
Primary
● Fall prevention (e.g. hand rails, cane)
● Immunization (including COVID-19, influenza, pneumococcal)
● Moderate physical activities
● Routine check-ups
● Well-balanced diet

Secondary
● Intake of cholinesterase inhibitors
● Cognitive tests
● Memory impairment screen
● Identification of clinical symptoms
● Imaging (e.g. CT or MRI*)

Tertiary
● Memory game (Sudoku Puzzle, Crossword puzzle)
● Crochet and Cross stitch
● Colonoscopy and other screening tests
● Family counseling: identification of caregiver, assess for caregiver fatigue
Case 1: Mayaman Family
Preventive Measures- AM, 65
Primary
● Comprehensive Geriatric Assessment
● Fall prevention (e.g. rails, cane)
● Immunization (including COVID-19, influenza, pneumococcal)

Secondary
● Monitoring of HbA1C, FBS, Lipid profile; Home CBG monitoring (kept in a diary)
● Moderate physical activities
● Low-glycemic diet
● Lifestyle modification
● Vitamin B complex
● Antihyperglycemic agents

Tertiary
● Comprehensive ophthalmologic exam
● Foot exam
● Regular check-up with a nephrologist
● Mammography, pelvic exam, and other screening tests
 Case 2
A 72 year old female diabetic consulted for CGA.
Height: 5 ft 2 inches | Weight: 70 kg
PE is normal except for hematoma in the upper and lower
extremities. She claims that she has not fallen.
MMSE: 22
GDS: 6
MNA: 23
Functional reach: 6 inches
Get up and Go test: 21 seconds
She had a CBC done yesterday and showed normal results.
HbA1c = 6.8 mg%
FBS = 110 mg/dl
BUN, creatinine and liver function tests
were normal.
Case 2
Functional Get up
BMI
Reach and Go
BMI = 70kg / 5ft 2in. ^2
6 inches 21 seconds
BMI = 70kg / 1.5748 m^2
BMI = 28.2 kg/m^2
A score of 6 or less indicates a >12 seconds:
significant increased risk for At Risk for Falling
Patient is under
falls.
Obese I
A score between 6-10 inches
in the Asian BMI
indicates a moderate risk for
Classification
falls
Reference: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
Reference: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
 Recall: A 72 year old female diabetic consulted for CGA. Height- 5 ft 2 inches
Weight- 70 kg. PE is normal except for hematoma in the upper and lower extremities.

CASE 2 She claims that she has not fallen. MMSE- 22; GDS- 6 MNA – 23. Functional reach 6
inches. Get up and Go Test = 21 seconds.She had a CBC done yesterday and showed
normal results. HbA1c = 6.8 mg%, FBS = 110 mg/dl, BUN, creatinine and liver function
tests were normal.
DOMAIN ASSESSMENT METHODS INTERPRETATION

MEDICAL ❖ HbA1c = 6.8 mg%, ❖ Diabetic

❖ FBS = 110 mg/dl ❖ Pre-diabetic
❖ BUN, creatinine, LFTs ❖ Normal
❖ PE: (+) hematoma, upper and lower extremities ❖ needs further evaluation
❖ BMI: 28.2 kg/m² ❖ Obese I
❖ MNA = 23 ❖ at risk
FUNCTIONAL ❖ functional reach = 6 inches ❖ moderate risk for falls
❖ Get up and Go test = 21 seconds ❖ at risk for falls → needs
detailed fall risk
assessment
PSYCHOLOGICAL ❖ MMSE = 22 ❖ mild cognitive
❖ GDS = 6 impairment → may use
the CDT as an adjunct
❖ Normal
SOCIAL ❖ Retirement? Financial Info? Past time activities? ❖ Must be assessed on next
❖ Environment? clinical visit
Case 2: Plan of management
❖ Advise compliance to maintenance medications
❖ Fall precautions
➢ Assistive device for ambulation
➢ Well-lit household
➢ Use of non-slip footwear
➢ Home hazards
❖ Regular exercise and balance training for at least 150
minutes/week
❖ Advise on use of proper orthotic devices
❖ Advise on low glycemic diet with multivitamins supplementation
to the patient’s daily regimen, and intake of supplemental milk
formula (Ensure: for memory loss; Anlene: for bone resorption
loss)
❖ Follow up check-ups in proper specialties (e.g. Ophthalmology,
Nephrology, Psychiatry)
Thank you!