As individuals age, physiological changes and a higher prevalence of chronic conditions necessitate a more focused approach to medical testing. A comprehensive geriatric assessment goes beyond a standard physical exam, incorporating medical, psychosocial, and functional evaluations to identify and manage the unique needs of older adults. The following sections outline the types of tests commonly ordered.
Routine Blood and Urine Tests
Routine laboratory tests provide a snapshot of a patient's overall health and help monitor chronic diseases. Age-related changes can affect normal reference ranges, so interpreting results requires clinical context.
Complete Blood Count (CBC)
A CBC measures red blood cells, white blood cells, and platelets. Lower red blood cell counts and hemoglobin levels can indicate anemia, a common condition in older adults that can cause fatigue and cognitive problems.
Metabolic Panels
A basic metabolic panel (BMP) or comprehensive metabolic panel (CMP) checks for:
- Blood Glucose: For screening and monitoring diabetes.
- Electrolytes: Including sodium and potassium, which can be imbalanced due to dehydration, certain medications, and reduced kidney function.
- Kidney Function: Measured by creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). A patient's age is a key factor in interpreting eGFR results.
- Liver Function: Liver function tests (LFTs) measure enzymes and proteins to assess liver health.
Thyroid Function Test (TSH)
An ultrasensitive Thyroid Stimulating Hormone (TSH) test is commonly used to screen for thyroid disorders. Both hyperthyroidism and hypothyroidism are common in the elderly and can cause symptoms like fatigue, weight changes, and cognitive decline.
Lipid Panel
This test measures cholesterol and triglyceride levels to assess the risk of heart disease and stroke.
Urinalysis
A routine urinalysis (U/A) screens for urinary tract infections (UTIs), kidney disease, and diabetes. In older adults, UTIs may present atypically, with confusion or behavioral changes rather than classic symptoms.
Cognitive and Functional Assessments
Age-related changes in cognition and function can significantly impact independence and quality of life. Standardized tests are used to evaluate these areas and guide treatment or supportive care.
Cognitive Screening
Tests like the Mini-Mental State Examination (MMSE) or Mini-Cog evaluate memory, language, orientation, and attention. These help identify dementia or other cognitive impairments.
Functional Assessment
These screenings evaluate a person's ability to perform activities of daily living (ADLs) such as dressing, bathing, and eating, as well as instrumental activities of daily living (IADLs), like managing finances and medication. Tests include:
- Timed Up-and-Go (TUG) test: Measures mobility, balance, and gait to assess fall risk.
- Mini Nutritional Assessment Short-Form (MNA-SF): A quick tool to identify older adults at risk of malnutrition.
Cancer and Other Disease Screenings
Guidelines exist for age-appropriate cancer screenings, but recommendations for older patients often consider a patient’s overall health and life expectancy.
Cancer Screenings
- Colorectal Cancer: Regular screening, which may involve colonoscopy or stool-based tests, is recommended for average-risk individuals through age 75.
- Breast Cancer (for women): Screening mammograms are recommended, often biennially after age 55. The decision to screen women over 75 is individualized.
- Prostate Cancer (for men): A PSA blood test and digital rectal exam are part of screening, but men over 70 should discuss the risks and benefits with their doctor.
- Lung Cancer: Annual low-dose CT scans are recommended for older adults who have a history of heavy smoking.
Bone Density Test
A DEXA scan measures bone mineral density to screen for osteoporosis, a condition that increases fracture risk. It is particularly recommended for women aged 65 and older.
Vision and Hearing Checks
Regular eye and ear exams are crucial for detecting age-related changes like glaucoma, cataracts, and hearing loss, which can impact safety, independence, and social engagement.
Medication Management and Vaccination Review
Polypharmacy, the use of multiple medications, is common in older adults and can lead to side effects and complications.
Comprehensive Medication Review
A thorough review by a physician or pharmacist can identify inappropriate medications, adverse effects, and simplify complex regimens.
Vaccinations
Healthcare providers ensure geriatric patients receive recommended immunizations, including annual influenza, shingles (herpes zoster), and pneumococcal vaccines.
Comparison of Common Geriatric Assessments
| Assessment Type | Purpose | How It Works |
|---|---|---|
| Routine Lab Tests | Monitor general health, organ function, and chronic disease status. | Blood is drawn for a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Thyroid Stimulating Hormone (TSH), and Lipid Panel. Urine is collected for a Urinalysis (U/A). |
| Cognitive Screening | Detect early signs of cognitive decline or dementia. | A healthcare provider administers a short, standardized test like the Mini-Cog or Mini-Mental State Exam (MMSE). |
| Functional Mobility Test | Assess mobility, balance, and risk of falling. | The patient is observed performing tasks, most commonly the Timed Up-and-Go (TUG) test. |
| Nutritional Screening | Identify patients at risk for malnutrition. | The provider uses a standardized questionnaire like the Mini Nutritional Assessment Short-Form (MNA-SF). |
| Cancer Screenings | Detect specific types of cancer early. | Procedures may include a colonoscopy for colorectal cancer, a mammogram for breast cancer, or a PSA test for prostate cancer. |
Conclusion
Comprehensive and tailored testing is fundamental to geriatric care. From routine blood work to functional and cognitive assessments, these evaluations provide a holistic view of an older adult's health, allowing for early detection and proactive management of potential issues. Regular screenings for conditions like cancer and osteoporosis, coupled with careful medication and vaccination reviews, are key components of maintaining independence and overall well-being. Ultimately, open communication between patients, caregivers, and healthcare providers is essential for creating a personalized and effective care plan for healthy aging.
