How to Assess an Elderly Patient: A Comprehensive Geriatric Guide

According to the U.S. Census Bureau, the number of Americans aged 65 and older is projected to nearly double by 2060. An effective way to comprehensively assess an elderly patient involves a holistic, multidisciplinary approach that addresses medical, functional, cognitive, and psychosocial domains to maximize their overall health and quality of life.

Quick Summary

A comprehensive geriatric assessment systematically evaluates an older adult's physical, functional, cognitive, and psychosocial health. This holistic process involves a multidisciplinary team to identify limitations, develop coordinated care plans, and improve overall well-being and independence.

Key Points

• Identify the reason for assessment: Understand the initial concern, which could be anything from memory issues to falls.

• Evaluate multiple domains: Cover physical health, function, cognition, mental state, medications, and social factors.

• Use validated screening tools: Employ tools like the Mini-Cog, GDS, and TUG for objective data on cognition, mood, and mobility.

• Conduct a thorough medication review: Check for polypharmacy using resources like the Beers Criteria to avoid interactions and side effects.

• Observe functional abilities: Watch simple tasks like standing or writing to gain insight into capabilities.

• Involve a multidisciplinary team: Collaborate with specialists like pharmacists, physical therapists, and social workers for optimal care.

• Adjust for communication challenges: Be mindful of sensory deficits and the tendency to underreport symptoms seen as normal aging.

The Importance of a Comprehensive Geriatric Assessment

Unlike standard medical evaluations focused on specific issues, a comprehensive geriatric assessment (CGA) provides a holistic view of a patient's health. This is vital as older adults often have atypical symptoms and multiple interacting chronic conditions. A CGA helps uncover problems like depression, malnutrition, or functional decline that impact quality of life.

Key Pillars of a Geriatric Assessment

A thorough geriatric evaluation goes beyond a physical exam to cover several crucial domains.

Physical Health and Function

• Physical Examination: Beyond standard checks, a geriatric exam includes vision tests (Snellen chart), hearing checks (whispered voice test), and observations for weight changes, bruises, or pressure injuries.
• Gait and Balance: Mobility assessment is key for fall prevention. Tests like the 'Timed Up and Go Test' (TUG), which times rising from a chair, walking 3 meters, turning, and returning to sit, indicate stability.
• Functional Status: This assesses ability to perform daily tasks, including Activities of Daily Living (ADLs) (bathing, dressing, eating) and Instrumental Activities of Daily Living (IADLs) (managing finances, cooking, taking meds). Standard scales like the Katz Index (ADLs) and Lawton Scale (IADLs) can be used.

Cognitive and Mental Health

• Cognitive Function: While some memory changes occur with age, significant decline is not normal. Screening tools like the Mini-Cog (three-item recall and clock-drawing) identify potential issues. More detailed tests like the Montreal Cognitive Assessment (MoCA) may follow.
• Mental Well-being: Depression is common but often missed in older adults. The Geriatric Depression Scale (GDS) is a screening tool. Assessing for anxiety and social isolation is also important.

Medication and Social Context

• Polypharmacy and Medication Management: Taking many medications increases risks of adverse events. A detailed review of all drugs, supplements, and remedies is crucial. The Beers Criteria helps identify problematic medications.
• Socioenvironmental Factors: Living situation, social support, and home safety are vital for independence. Inquire about living arrangements, caregivers, finances, and consider a home safety assessment.

Practical Assessment Steps

1. Gather Information Beforehand: Have the patient or family complete a questionnaire about activities, history, and risks if possible.
2. Conduct a Multi-Domain Evaluation: Systematically assess all pillars during the visit using simple, validated tools for function, cognition, and mood. Observing gait upon entry provides insight.
3. Address Potential Barriers: Be aware of sensory issues like hearing loss that hinder communication. Use clear language and remember patients may underreport symptoms seen as normal aging.
4. Collaborate with a Multidisciplinary Team: A team including nurses, social workers, pharmacists, and physical therapists ensures a comprehensive, coordinated care plan.
5. Follow-Up and Plan: Based on findings, create a problem list and a tailored plan involving referrals, therapy, medication changes, or social support. Monitor progress and adapt the plan as needed.

Comparison of Standard vs. Geriatric Assessment

Aspect	Standard Medical Assessment	Comprehensive Geriatric Assessment (CGA)
Scope	Focused on a specific disease or presenting complaint.	Broad, multidimensional view of health and well-being.
Domains	Medical history, focused physical exam.	Medical, functional, cognitive, mental health, and psychosocial.
Team	Typically involves a single physician.	A multidisciplinary team (e.g., geriatrician, nurse, pharmacist, social worker).
Focus	Diagnosis and treatment of specific pathology.	Maximizing functional capacity, independence, and quality of life.
Tools	Standard diagnostic tests.	Incorporates validated screening tools (e.g., Mini-Cog, GDS, TUG).
Outcome	Resolution or management of the presenting issue.	A coordinated, holistic care plan that addresses multiple interacting problems.

Conclusion

The comprehensive geriatric assessment is vital for providing high-quality care to older adults. By evaluating physical, functional, cognitive, and psychosocial health systematically, providers can find complex issues easily missed in a standard exam. This team-based approach leads to a better understanding of patient needs and an integrated plan that improves health, independence, and quality of life. The CGA is a cornerstone of effective and compassionate geriatric care.

Visit the American Academy of Family Physicians for more on geriatric assessment best practices.

Frequently Asked Questions

What is the primary difference between a standard and geriatric assessment?

A standard assessment focuses on a specific problem, while a geriatric assessment is a comprehensive evaluation covering an older patient's physical, functional, cognitive, mental, and psychosocial health.

How do you assess an elderly patient's cognitive function?

Screening tools like the Mini-Cog, which includes a three-item recall and a clock-drawing test, are used. Positive results may lead to a more detailed evaluation with tools like the MoCA.

Why is a medication review so important for older patients?

Older adults often take multiple medications (polypharmacy), increasing the risk of adverse drug events and interactions. A review helps identify potentially inappropriate medications.

What is the Timed Up and Go Test?

The Timed Up and Go Test (TUG) screens gait and balance. The patient is timed rising from a chair, walking 3 meters, turning, and sitting back down. Over 12 seconds may indicate increased fall risk.

How can I assess a patient's functional abilities at home?

Ask about Activities of Daily Living (ADLs) like bathing and eating, and Instrumental Activities of Daily Living (IADLs) such as managing finances. Use scales like the Katz or Lawton, and recommend a home safety assessment.

What should be considered when a patient underreports symptoms?

Patients may see issues like memory loss as normal aging. Ask specific questions about routines and observe function directly, as decline might be the only sign of a problem.

How does social support factor into a geriatric assessment?

A patient's social network is crucial for well-being and independence. Assessing living arrangements and caregiver involvement helps identify needed resources, impacting the care plan and health outcomes.