Title

Prepared by: Elery Michelle C. Quiben, RN,MSN

Comprehensive Geriatric Assessment
• A multidimensional interdisciplinary diagnostic process
focused on determining a frail older person’s medical,
psychological & functional capability in order to develop a
coordinated & integrated plan for treatment & long term
follow up.
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
Personal Data Assessment
 Financial Health Planning
Primary source of
healthcare

Financial resources
related to illness
Medical Assessment
HEART
✓it grows slightly larger with age.
✓Maximal oxygen consumption during
exercise declines in men by about 10%
with each decade of life while women is
about 7.5%.
✓Cardiac output stays nearly the same
as the heart pumps more efficiently.

LUNGS
✓ maximum breathing (vital) capacity
may decline by about 40% between
ages 20 and 70.
 Medical Assessment
SKIN
General Appearance
✓Structural changes such as dryness, roughness,
wrinkling, laxity and increased incidence of
neoplasms, both benign and malignant.
✓Functional changes such as decline in cell
replacement, barrier function, wound healing,
immunologic response and thermoregulation.
HAIR
✓Substantially grays in about 50% of persons by
age 50 due to loss of melanocytes.
✓Hair loss from the vertex and fronto-temporal
regions in men begins between the late teens and
the late 20’s, by the time they reach 60’s, 80% of
men are substantially bald.
✓Same pattern of hair loss for women after
menopause.
Medical Assessment
Leading causes of Illness (morbidity)
among older Filipinos
➢Influenza
➢Bronchitis
➢TB
➢Diarrhea
➢Hypertension
Leading Cause of death (mortality)
➢Diseases of the heart
➢Diseases of the vascular
system
➢Pneumonias
➢TB (all forms)
➢Malignant neoplasms
Medical Assessment
SIGHT
✓ Difficulty focusing close up
may begin in the 40’s
✓Ability to distinguish fine
details may begin to decline
in the 70’s
✓From 50 onwards, there is
increased susceptibility to
glare, greater difficulty in
seeing at low levels of
illumination, and more
difficulty in detecting moving
targets.
Medical Assessment

HEARING
✓ It becomes more difficult
to hear higher frequencies
with age
✓ hearing declines more
quickly in men than women.
Medical Assessment
Medical Assessment
 BRADEN SCALE
• Developed 1984 by Braden and Bergstrom

• Six elements that contribute to either higher intensity and duration of pressure or lower
tissue tolerance to pressure therefore increasing the risk of pressure ulcer development.

- Sensory perception - Mobility (ability to change own

position)
- Nutrition - Moisture
- Friction and shear - Activity

• Each item is scored between 1 and 4 guided by a descriptor.

The lower the score, the greater the risk.
15 + = low risk
13-14 = moderate risk
12 or less = high risk
Below 9 = severe risk

• Limitations: Does not consider pre existing or previous pressure ulceration

 Example of Braden
Sensory Friction and
Moisture Activity Mobility Nutrition
Perception Shear

No Walks No
4 Rarely Moist 4 4 4 Excellent 4
Impairment Frequently Limitations

Slightly Occasionally Walks Slightly No Apparent

3 3 3 3 Adequate 3 3
Limited Moist Occasionaly Limited Problem

Probably Potential
Very Limited 2 Very Moist 2 Chair bound 2 Very Limited 2 2 2
Inadequate Problem

Completely Constantly Completely

1 1 Bedbound 1 1 Very Poor 1 Problem 1
Limited Moist Immobile
 Sensory perception 2. Very Limited 3. Slightly Limited 4. No Impairment
1. Completely Limited
Unresponsive (does not Responds only to Responds to verbal Responds to verbal
moan, flinch or gasp) to painful stimuli. Cannot commands, but cannot commands. Had
painful stimuli, due to communicate always communicate no sensory deficit
diminished level of discomfort except by discomfort or need to which would limit
consciousness or moaning or be turned OR has some ability to feel or
sedation. OR limited restlessness sensory impairment voice pain or
ability to feel pain over which limits ability to discomfort.
Ability to respond most of body surface. feel pain or discomfort
in 1 or 2 extremities
meaningfully to
pressure-related
discomfort
 1. Constantly Moist
Moisture
2. Very Moist 3. Occasionally Moist 4. Rarely Moist
Skin is kept moist Skin is often, but not Skin is occasionally Skin is usually dry.
almost constantly by always moist. Linen moist, requiring an Linen only requires
perspiration, urine, must be changed at extra linen change changing at routine
etc. Dampness is least once a shift. approximately once a intervals.
detected every time day.
patient is moved or
turned.

Degree to which
skin is exposed to
moisture
 1. Bedfast
Activity
2. Chairfast 3. Walks Occasionally 4. Walks Frequently
Confined to bed. Ability to walk Walks occasionally Walks outside the room
severely limited or during day, but for very at least twice a day and
non-existent. Cannot short distances, with or inside room at least once
bear own weight without assistance. every 2 hours during
and/or must be Spends majority of each waking hours.
assisted into chair or shift in bed or chair.
wheelchair.
Degree of physical
activity
 1. Completely
Mobility
2. Very Limited 3. Slightly Limited 4. No Limitations
Immobile Makes occasional slight Makes frequent though Makes major and
Does not make even changes in body or slight changes in body frequent changes
slight changes in body extremity position but or extremity position in position without
or extremity position unable to make independently. assistance.
without assistance. frequent or significant
changes independently.
Ability to change
and control body
position
 Nutrition
1. Very Poor 2. Probably 3. Adequate 4. Excellent
Never eats a complete Inadequate Eats over half of most Eats most of
meal. Rarely eats more Rarely eats a complete meals. Eats a total of 4 every meal. Never
than 1/3 of any food meal and generally servings of protein refuses a meal.
offered. Eats 2 eats only about ½ of each day. Occasionally Usually eats a
servings or less of any food offered. Eats will refuse a meal, but total of 4 or more
protein per day. Takes only 3 servings of will usually take a servings of
fluids poorly. Does not protein per day. supplement if offered. protein per day.
Usual food take a liquid dietary Occasionally will take OR is on a tube Occasionally eats
intake pattern supplement. OR is a dietary supplement. feeding or TPN between meals.
NBM and/or OR receives less than regimen which Does not require
maintained or clear optimum amount of probably meets most supplementation.
liquids or IVs for more liquid diet or tube of nutritional needs.
than 5 days. feeding.
 Friction and shear
1. Problem 2. Potential Problem 3. No apparent
Requires moderate to Moves feebly or problem
maximum assistance requires minimum Moves in bed and in
in moving. Complete assistance. During a chair independently
lifting without sliding move, skin probably and has sufficient
against sheets is slides to some extent muscle strength to
impossible. against sheets or lift up completely
Friction and Frequently slides other surfaces. during move.
Shear down bed or chair, Maintains relatively Maintains good
requiring frequent good position in chair position in bed or
repositioning with or bed most of the chair at all times.
maximum assistance. time, but occasionally
Spasticity, slides down.
contractures or
agitation lead to
almost constant
friction.