Comprehensive Geriatric Assessment Principles and Tools
Comprehensive Geriatric Assessment
A comprehensive geriatric assessment consists of a clinical evaluation, functional rating, and mental, emotional, and social assessments.
Basic Principles of Geriatric Care
Due to the complexity of their problems, many elderly individuals require a broad, multidisciplinary diagnostic approach. Key principles include:
- There is a high prevalence of unrecognized, reversible diseases, disorders, and dependencies.
- Many elderly patients can respond dramatically to treatment.
- No patient should be institutionalized without a comprehensive assessment.
Objectives of the Geriatric Evaluation
- To improve diagnostic accuracy and identify problems.
- To set objectives and ensure a rational care plan.
- To understand the patient’s situation to predict their evolution and observe changes over time.
- To ensure the proper use of resources and services.
- To determine the optimal living situation for the patient and avoid unnecessary institutionalization.
Aspects of Interviewing the Elderly
When interviewing an elderly person, the following should be considered:
- Maintain a friendly and respectful attitude.
- Ask for permission before proceeding and avoid prolonged, exhaustive interrogations.
- Create a calm environment and avoid family disruptions.
- Use clear, simple language.
- Ensure the person has their glasses, dentures, or hearing aids if needed.
- Provide adequate lighting.
- Allow the necessary time for them to answer.
- Develop a structured interview.
- If cognitive impairment is present, the presence of a caregiver is essential.
Clinical Rating
Clinical evaluation in the elderly is complex due to several factors:
- Atypical Presentation: Illnesses often present atypically or without classic symptoms (e.g., a heart attack without pain, pneumonia without fever).
- Undiagnosed Diseases: The presence of multiple, previously undiagnosed diseases is common.
- Masked Symptoms: Symptoms of one disease can hide another.
- Function vs. Organ: The alteration of a function does not always depend on the most obviously related organ system.
- Treatment Complications: The treatment of one disease may worsen another.
- Problem Cascade: The treatment of one disease can cause a bigger problem.
- Vicious Cycle: The coincidence of multiple diseases can generate a reciprocal influence, perpetuating the patient’s complaints.
Functional Assessment
Functional assessment is defined as the capacity of a person to perform activities independently and effectively. This includes both basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which allow them to adapt to everyday problems.
Katz Index of ADL
The Katz Index is one of the first rating scales for comparing Basic Activities of Daily Living (ADLs). It does not provide a numerical value but instead uses a hierarchical pattern. It consists of six items:
- Bathing
- Dressing
- Toileting
- Transferring
- Continence
- Feeding
Each activity is evaluated in terms of independence, and the results are converted to an alphabetical index that assigns a hierarchical category for overall performance.
Barthel Index
The Barthel Index provides additional information to the Katz Index and is equally simple and easy to administer. A final score is obtained by aggregating the scores of individual variables. It evaluates ten basic activities:
- Feeding (10 points)
- Bathing (5 points)
- Grooming (5 points)
- Dressing (10 points)
- Bowel continence (10 points)
- Bladder continence (10 points)
- Toileting (10 points)
- Transferring (bed to chair) (15 points)
- Mobility (15 points)
- Climbing stairs (10 points)
The total possible score is 100.
Lawton and Brody IADL Scale
This simple and concise scale measures Instrumental Activities of Daily Living (IADLs). It assesses the capacity to perform eight activities:
- Using the telephone
- Shopping
- Preparing food
- Housekeeping
- Doing laundry
- Using transportation
- Managing medications
- Managing finances
Each item is scored as 1 (able) or 0 (unable). This scale gives significant importance to housework, so in some environments, men may score lower due to traditional gender roles. It evaluates the ability to function in specific circumstances, such as after becoming a widow. The availability of appliances and other utensils may also influence the score.