Practical Geriatric Assessment

Tia Kostas; Allison Paquin; James L Rudolph

Disclosures

Aging Health. 2013;9(6):579-591. 

In This Article

Abstract and Introduction

Abstract

Preserving function is a priority in caring for older patients. In geriatrics, the focus of care shifts from the treatment of multiple chronic diseases to the impact of these chronic diseases on function. Clinicians must conduct functional assessments in order to establish a baseline and identify changes over time. This article gives the healthcare provider practical tools to assess function and conditions that impact function in a busy clinic setting. Since functional abilities represent the integration of the effects of multiple, complex disease states, it is important to perform a comprehensive assessment of key domains, including physical, cognitive, psychological and social domains. For each domain, we will present practical tools for screening (<2 min) as well as tools for more in-depth assessments (<10 min). Healthcare providers are encouraged to use these tools to help care for their older patients, all while keeping in mind individual patient function, safety and goals of care.

Introduction

In geriatrics, the fundamental focus of care shifts from management and treatment of multiple chronic diseases to the impact of such diseases on function. Function can be defined as the ability to survive in one's environment. As the geriatric population is quite heterogeneous, this definition is intentionally broad to create an individual meaning for each patient. Measuring functional status allows healthcare providers to choose the most appropriate setting or level of support for each patient. The challenge of the clinician caring for the older patient becomes describing, assessing and preserving function.

The purpose of this article is to give the healthcare provider practical screening and assessment tools to evaluate function and conditions that impact function in a busy clinical setting. While research has identified many valuable instruments, use of such instruments in the clinical setting is not always feasible. Furthermore, given the time constraints imposed on clinicians in modern clinical practice, it is impractical to conduct lengthy screening assessments in all domains on all patients at every visit. Thus, for each functional domain, this article presents a short screening tool (1–2 min) that clinicians can use routinely, and a more comprehensive assessment tool (<10 min) for use in patients who fail initial screenings. Clinicians may focus on all of the domains included in this review in order to perform a more comprehensive geriatric assessment, or they may pick and choose specific areas of screening based on patients' needs.

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