Although the majority of elderly persons enjoy good health, many older adults suffer from multiple illnesses and significant disabilities, including medical, cognitive, behavioral and functional problems. These interrelated conditions often put them at high risk for premature or inappropriate institutionalization.
Whether or not the patient has a diagnosis of dementia or some type of mental impairment, the family or caregiver often seeks validation of the current treatment approach or a patient’s recommended level of care. This process can be accomplished by a Geriatric Assessment Consultation.
The Geriatric Assessment Consultation is conducted in one visit by a team consisting of a Geriatrician, Geriatric Nurse Specialist and Social Worker. Our geriatric assessments include the following categories.
We approach each patient as a team.
History and Physical Examination
A full medical history will be obtained from the patient and family. Attention is paid to the use of prescriptions and non-prescription medications. A comprehensive physical exam is also conducted, and any lab tests, CAT scans, MRIs and other diagnostic tests will be ordered as needed.
Assessment of Behavioral Issues and Level of Functioning
Special attention is paid to any clues to the presence of malnutrition, falling, incontinence, immobility, wandering and forgetfulness. Cognitive, emotional and behavioral states are evaluated for detection of dementia, delirium and depression. The team identifies present and future caregivers and evaluates their needs as well as the degree of caregiver stress, and a support network is outlined. Economic resources are also evaluated since they often determine and influence options for supportive care and living arrangements. A functional assessment is conducted to evaluate the patient’s ability to accomplish basic activities of daily living (ADL’s) as well as behavioral and social activities that require higher levels of cognition and judgment. A patient’s home environment is assessed through questionnaire and interview.
Suggested Plan of Care
After the assessments and evaluations have been completed, the team generates a comprehensive list of the patient’s needs and strengths. Recommendations are then integrated into an individualized plan of care to be shared with the patient, family and caregivers, and then with the patient’s primary physician. The consultation is not intended to replace the family doctor but rather to guide patients and families to services and treatments through the recommended plan of care.
A recommended plan of care may include: medication change, physical, occupational or speech therapy evaluation, adult day services, skilled home care, facility placement and/or referral to other community resources as needed. The consultation team is available to assist the patient and family to carry out these recommendations. Additional visits are scheduled at the discretion of the physician.
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