Geriatrics

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
  •  
• 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.

Delirium

• • TODO