Wednesday, April 26, 2017

Approach To Elderly Patient

Family physicians are responsible for caring increasing number of elderly patients.Older patients have co morbidities, functional, psychological and social problems that need to be considered by the the family physician.

Goals of Geriatric Assessment

1. Focus on preventive medicine rather than acute medicine.
2. Focus on improving or maintaining functional ability and not necessarily on a “cure.”
3. Provide a long-term solution for “difficult to manage” patients with multiple physicians, recurrent emergency department visits, and hospital admissions with poor follow-up.
4. Aid in the diagnosis of health-related problems.
5. Develop plans for treatment and follow-up care.
6. Establish plans for coordination of care.
7. Determine the need and site of long-term care as appropriate.
8. Determine optimal use of health care resources.
9. Prevent readmission into the hospital.

The geriatric assessment can be divided into four categories: medical, functional, psychological, and social.

Medical Assessment The medical assessment includes a review of the patient’s medical record, medication history (past and present), and a nutritional evaluation. On average, elderly patients have four to six diagnosable disorders, which may require the use of several medications. One disorder can affect another, and in turn a collective deterioration of both can lead to overall poor outcomes.

During the medical assessment, the review of systems should be completed with special emphasis on sensory impairment, dentition, mood, memory, urinary symptoms, falls, nutrition, and pain.

Hearing loss is the third most prevalent chronic condition in elderly people, after hypertension and arthritis, and its prevalence and severity increase with age.

Review of the patient’s current medication list, including over-the-counter (OTC) medications, as well as any drug allergies or previous adverse drug reactions, is a necessary component of the geriatric assessment. Polypharmacy is defined as taking more than four medications and is an independent risk factor for both delirium and falls. Patients or family members should be asked to bring in all the patient’s prescription medications and supplements at the initial visit and periodically thereafter.

Nutritional evaluation is an integral part of the geriatric assessment. The type, quantity, and frequency of food eaten should be determined. Malnutrition and undernutrition can lead to health problems that include delayed healing and longer hospital stays.

Functional Assessment
A primary goal of the geriatric assessment is to identify interventions to help patients maintain function and stay at home in independent living situations.

Psychological Assessment
The psychological assessment screens for cognitive impairment and depression, two conditions that significantly impact both the patient and the family.

Social Assessment
It is important to assess the patient’s living situation and social support when performing a geriatric assessment. The living situation should be evaluated for potential hazards, especially if the patient is identified as being at risk of falling. The social assessment also includes questions about financial stressors and caregiver concerns.

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