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The geriatric assessment is a multidimensional, multidisciplinary assessment and the key elements of the assessment is to assess the older person’s functional ability, physical health, cognition and mental health and his/her socioenvironmental circumstances. It differs from typical medical evaluation since it includes non-medical domains by emphasizing on functional capacity, quality of life and it incorporates other disciplines like physicians, nutritionists, physical and occupational therapists, and social workers.
Physical Health
This incorporates all facets of conventional medical history including the current illness, family and social history and a review of all systems. However special considerations should be taken when assessing the patient’s nutrition, vision, hearing, fecal and urinary incontinence, balance and fall prevention and a review of all the medications that the patient is taking. Nutrition assessment should include assessment of the patient’s normal food intake and particular attention taken to assess for any signs of malnutrition or obesity, for the vision, assess for conditions that cause impaired vision in geriatrics including, diabetic retinopathy, cataracts and age related macular regeneration. A hearing assessment should also be performed using an otoscope or whispered voice test and all patient’s medications examined for any potential ototoxicity. Assess for any urine or fecal incontinence which combined with immobility are the biggest causes of decubitus ulcers and eventual sepsis. Impaired balance in the elderly normally manifests in fall related injuries. Balance can be assessed by how the patient gets up from a chair, how they walk and turn, assess if they have an unsteady gait. This can also be manifested by skin assessment where the patient has scattered bruising or hematomas. (Geriatric assessment, American family physician 2011).
Cognitive and Mental Health
Altered cognition is not a normal part of aging and the nurse may need to pay close attention to the possibilities of the onset of dementia. Cognitive impairment in older adults has a variety of possible causes, including medication side effects, metabolic and endocrine derangements, delirium due to illness, depression, and dementia, with Alzheimer’s dementia being most common. Some causes, like medication side effects and depression, can be reversed with treatment. Others, such as Alzheimer’s disease, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for predictable changes. Patients should be screened for cognitive impairment if the person, family members, or others express concerns about changes in his or her memory or thinking, or you observe problems /changes in the patient’s memory or thinking or if the patient is age 80 or older. (Barnes et al, 2014)
Socioenvironmental circumstances
Determining the living arrangements for the geriatric patient is part of the geriatric assessment. Most of the older population live with their spouses or the extended family. Although options vary widely there are three basic types depending on the patient’s health, and cognitive impairment. They include private homes in the community, (where patients live alone but have home health services) assisted living residences (patients live in a home but are basically independent, only assisted with those tasks that they are unable to do themselves) and skilled nursing facilities (includes rehabilitation hospitals and nursing homes). Assess the patient and involve the social workers in determining the ideal placement for the patient.(Geriatric assessment, American family physician 2011).