Geriatrics

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    Cognitive Assessment

    • MOCA is likely the best test.
    • Do not use the Folstein's MMSE unless they have <9grade education.

     

    Memory Assessment

    • One of the new best memory assessment screens are:
      • 1. 3 Item Recall
        • Can use Dr. Carballman (Car, Ball, Man)
      • 2. Lists as many animals as possible in 1 minute.
        • <15 is 20.2 Odds Ratio for Dementia/Memory deficit.
      • 3. Clock Drawing
        • Draw a circle for them, tell them to fill in numbers, and ask for "10 past 11".

     

    Falls Assessment

    • Complete History and Physical
    • Timed Get Up and Go Test 
      • Ask the patient to get up from the chair without using the handles, walks 3 meters, and come back and sit back down.  (can use walking devices and regular shoes etc...)
      • Scoring
        • <10s considered normal.
        • 11-20s within normal limits of frail/elderly
        • >20s needs assistance.
        • Overall: >14 increased risk of falls.
    • Chair Stand
      • getUPAndGoTest.png Screen Shot 2013-11-17 at 10.46.22 PM.png
    • Romberg Test
      • Have the patient stand with eyes open for 20-30s.  They should be able to stand still.  Then have patient stand still with eyes closed for 30 seconds.  Positive Rhomberg is there is a sway.
    • Pull Test
      • Pull, to see if they can regain posture??
    • 20 foot walk with 360° turns

     

    • Possible reasons for falling:
      • Weakness of leg extension
        • Impaired chair stand,
        • Slow Gait,
        • Poor stair climbing)
      • Poor balance
        • Positive Romberg test
        • Positive Pull test
        • Poor vision.
      • Medication Toxicity
        • Alcohol, Anticholinergics, Anticonvulstants, Antihypertensives, Digoxin, Nitrates, Sedatives
      • Hypotension
        • Orthostatic, Postprandial.

     

     

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