Recognizing the signs that an elderly person needs evaluation
Observing changes in a loved one's behavior, health, or living situation is often the first indicator that a comprehensive evaluation is needed. These signs can be subtle and develop over time, making it important to pay attention to patterns rather than isolated incidents.
Changes in physical capabilities and appearance
- Mobility issues: Holding onto furniture when walking, difficulty getting up from a chair, frequent falls or unexplained bruises.
- Poor hygiene: Wearing soiled or tattered clothing, an unkempt appearance, or an unpleasant body odor may indicate they are struggling with daily tasks like bathing and dressing.
- Significant weight changes: Unexplained weight loss or gain can be a sign of poor nutrition, depression, or underlying medical conditions.
Cognitive and memory issues
- Forgetfulness and confusion: While occasional forgetfulness is normal, frequent or recurring memory problems are a red flag for dementia or other serious conditions. This can include missing appointments, forgetting to take medication, or getting lost in familiar places.
- Impaired judgment: Using poor judgment, such as falling for scams or giving out financial information, is a common sign of cognitive decline.
Behavioral and emotional changes
- Mood swings or personality shifts: Sudden changes in personality or exhibiting increased agitation, anxiety, or sadness can be symptoms of depression or a neurological issue.
- Social withdrawal: Losing interest in hobbies and activities they once enjoyed or withdrawing from social interactions can be a sign of depression or loneliness.
Neglecting responsibilities
- Medication management: Incorrect dosages, forgotten pills, or unopened mail containing prescriptions point to challenges in managing their health.
- Household chores: A cluttered or unsanitary home, spoiled food in the fridge, or stacks of unpaid bills can signal a decline in functional ability.
The process for getting a comprehensive geriatric assessment
Once concerns are identified, arranging a Comprehensive Geriatric Assessment (CGA) is the next step. This process is more thorough than a standard check-up and involves a multidisciplinary team to evaluate an older person's medical, mental, and functional status.
Step 1: Initial conversation and gathering information
Start by having an empathetic and respectful conversation with your loved one, explaining that the evaluation is for their safety and well-being. Gathering a complete medical history, including current medications, over-the-counter supplements, and a timeline of your observations, will be essential for the assessment. Consider creating a log of specific changes you have noticed.
Step 2: Involve the primary care physician (PCP)
The first professional to contact is typically the elderly person's PCP. The PCP can perform an initial screening and, if necessary, refer them to a geriatrician or a geriatric assessment program. You can share your concerns with the doctor, especially if your loved one is hesitant to go. A HIPAA release form is required for you to receive medical information directly.
Step 3: Schedule a geriatric assessment
This assessment can be done in an outpatient clinic, a hospital, or, in some cases, at the elderly person's home. The assessment involves a team of specialists and may require a few visits.
Step 4: Develop a personalized care plan
After the assessment, the team will develop a coordinated care plan tailored to your loved one's specific needs, which is a key benefit of the CGA. This plan addresses identified problems and sets goals for treatment and long-term care.
Comparison of assessment types
| Aspect | Initial Primary Care Evaluation | Comprehensive Geriatric Assessment (CGA) |
|---|---|---|
| Scope | General health check, problem-focused | Holistic, multidimensional assessment of physical, cognitive, and psychosocial health |
| Team | Typically conducted by a single physician | Multidisciplinary team: geriatrician, nurse, social worker, physical therapist, and others |
| Setting | Doctor's office | Can be conducted in a clinic, hospital, or at home |
| Output | Diagnosis of immediate medical problems | Integrated care plan addressing a broad range of issues, from medical diagnoses to social support |
| Goal | Address immediate health concerns | Improve overall quality of life and functional capacity |
Specialists and resources for finding help
Finding the right professionals can make the evaluation process smoother. If your loved one's PCP is not a geriatrician, a referral may be necessary.
- Geriatrician: A physician specializing in the care of older adults. You can find one through the American Geriatrics Society's Health in Aging Foundation website.
- Neuropsychologist: If cognitive issues like dementia are a primary concern, a neuropsychologist is specialized in diagnosing brain disorders and assessing thinking abilities.
- Eldercare Locator: A public service of the U.S. Administration on Aging that connects you to local resources and services for older adults and their families.
- Aging Life Care Association: Can help you find a geriatric care manager who can coordinate and oversee the entire assessment and care plan.
- Adult Protective Services (APS): In cases of severe self-neglect or safety concerns where the elderly person is refusing care, APS can get involved to assess the situation.
Conclusion
Getting an elderly person evaluated, particularly through a Comprehensive Geriatric Assessment (CGA), is a proactive and vital step toward ensuring their safety, health, and dignity. By recognizing the early signs of decline, engaging with healthcare professionals, and preparing a detailed history, caregivers can initiate a process that leads to a clearer diagnosis and a tailored plan of care. The CGA's multidisciplinary approach focuses on improving functional ability, managing medications, and addressing underlying physical and mental health issues, ultimately enhancing the older adult's overall quality of life and promoting independence. For those with multiple complex health needs, a CGA is a highly effective tool for navigating the complexities of aging and preventing adverse health outcomes.
Next steps for the resistant elderly person
If an elderly loved one is resistant to the idea of an evaluation, it's essential to approach the conversation with empathy and patience. Try reframing the discussion by focusing on the benefits rather than the deficits. For example, explain that the evaluation is a way to ensure they can maintain their independence and continue to live comfortably at home. Offering to accompany them to the appointment can also provide reassurance and support. Continuing to engage with them and involving trusted friends or family members can help build a foundation of trust over time. The goal is to collaborate with them, not force them, to accept the help they need.
Actionable checklist for caregivers
- Monitor behavior and routines: Keep a written log of changes in mood, memory, physical ability, and household management.
- Gather health information: Compile a complete list of all medications, including dosages, and collect past medical records.
- Start with the PCP: Contact the primary care physician to discuss your concerns and ask for an initial screening or referral.
- Consider a geriatrician: If the PCP is not a specialist in geriatric care, seek a referral for a CGA.
- Use resources: Utilize tools like the Eldercare Locator or the Health in Aging Foundation to find local specialists and services.
- Attend appointments: Go with your loved one to their appointments to provide context, take notes, and ask questions.
- Explore funding: Inquire about Medicare coverage for cognitive assessments and care planning services.
- Formulate a care plan: Collaborate with the multidisciplinary team to create a goal-oriented plan for managing care.
By following these steps, you can help an elderly person receive a thorough evaluation, leading to a more informed and effective path for their ongoing care.
