Table of contents
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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".
- 1. 3 Item Recall
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.
- Weakness of leg extension
Delirium
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- TODO
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