August 2001 • Volume 7 • Number 8
Geriatric assessment addresses quality of life
BY SHARON DICKINSON DENT
With the dramatic rise in the number of older patients, physicians are learning that assessing the elderly means much more than just asking health-related questions. Getting a feel for how well a patient deals with the challenges of daily life can open the door to better medical care and improved quality of life.
Peilan Sun, who lives at home with her daughter in Bellevue, Wash., sees Wayne McCormick, M.D., for an exam at Harborview Senior Care Clinic."It's almost never about cure; it's always about functional improvement," says Wayne McCormick, M.D., M.P.H., associate professor at the University of Washington School of Medicine and program director for long-term care services at Harborview Medical Center in Seattle.
"It's additive and synergistic," says McCormick, who has helped teach the Family Practice Board Review course. "If older people have trouble with a couple things that you might think are minor, those are the kinds of things that could land them in the hospital. If they can't bathe well or at all, then they get skin problems, which in a diabetic can turn into infections and become life threatening."
Patients who visit McCormick at the Harborview Senior Care Clinic succumb to the typical blood pressure, pulse and weight checks, but they also answer a series of questions designed to ferret out cognitive concerns or problems with daily activities. Nurses use three tools -- the Mini-Mental Status Exam, Instrumental Activities of Daily Living and Physical Activities of Daily Living -- to assess a patient at intake and later as indicated by patient complaints or symptoms. The information is then added to the patient's chart for easy review by the physician.
The Mini-Mental Status Exam calls on patients to answer basic orientation questions (day of the week, name of the town, etc.), list three unrelated objects and be able to recall them later, perform serial subtraction, name two objects identified by the nurse, write a sentence, copy a geometric design, follow written and oral directions, and repeat a phrase.
The Instrumental Activities of Daily Living tool surveys how well the patient can use the telephone, shop, prepare food, maintain the home, do laundry, use transportation, take medication and manage finances.
The Physical Activities of Daily Living tool determines whether the patient needs help bathing, dressing, grooming, using the toilet, getting in and out of bed, or walking and eating. The test also asks for the names of anyone who helps the patient with these tasks.
"In geriatrics, often the underlying diagnoses -- like osteoarthritis or heart failure -- matter, but maybe they don't matter as much as trouble bathing or trouble dressing. We might address those directly without needing another physical diagnosis to attach to it. So if someone's having trouble bathing, we might arrange to have a bath aide come in once a week," says McCormick.
Most physicians haven't been trained to use these types of assessments and often don't realize how valuable they can be, he says. "Recognize that each visit is part of a long conversation and allow for that," he suggests. "When these assessments come up, driven by intake or complaints, remember that the serial use of them is useful to add weight or perspective to the visit. Knowing these types of things about people adds a lot to the conversation."
For more articles on care of the elderly, access http://www.aafp.org/fpr/20010700 and click on stories listed under "Geriatric Medicine." Use "Quick Fax" on page 8 for materials on the next AAFP geriatrics course.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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