If you had to take medication, could you do it?Īdverse effects from medication, autonomic dysfunctionĪdverse effects from medication, atherosclerosis, coronary artery diseaseĪdverse effects from medication, heart block With some help (take medication if someone prepares it for you or reminds you to take it)Ĩc. Without help (in the right doses at the right time) Can you get to places that are out of walking distance?Ĭompletely unable to travel unless special arrangements are madeĬompletely unable to do any handyman work Needs partial or total help with feeding or requires parenteral feedingįor each question, circle the points for the answer that best applies to your situation.Ģ. Gets food from plate into mouth without help preparation of food may be done by another person Is partially or totally incontinent of bowel or bladder Needs help in moving from bed to chair or requires a complete transferĮxercises complete self-control over urination and defecation Moves in and out of bed or chair unassisted mechanical transfer aids are acceptable Needs help transferring to the toilet and cleaning self, or uses bedpan or commode Goes to toilet, gets on and off, arranges clothes, cleans genital area without help Needs help with dressing self or needs to be completely dressed Gets clothes from closets and drawers, and puts on clothes and outer garments complete with fasteners may need help tying shoes Needs help with bathing more than one part of the body, getting in or out of the bathtub or shower requires total bathing 9 Deficits in ADL and IADL can signal the need for more in-depth evaluation of the patient's socioenvironmental circumstances and the need for additional assistance.īathes self completely or needs help in bathing only a single part of the body, such as the back, genital area, or disabled extremity Two instruments for assessing ADL and IADL include the Katz ADL scale ( Table 1) 8 and the Lawton IADL scale ( Table 2). Physicians can acquire useful functional information by simply observing older patients as they complete simple tasks, such as unbuttoning and buttoning a shirt, picking up a pen and writing a sentence, taking off and putting on shoes, and climbing up and down from an examination table. IADL are activities that are needed to live independently (e.g., doing housework, preparing meals, taking medications properly, managing finances, using a telephone). ADL are self-care activities that a person performs daily (e.g., eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions). The geriatric assessment begins with a review of the two key divisions of functional ability: activities of daily living (ADL) and instrumental activities of daily living (IADL). When multiple concerns are presented, the use of a “rolling” assessment over several visits should be considered.įunctional status refers to a person's ability to perform tasks that are required for living. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. Well-validated tools and survey instruments for evaluating activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the geriatric assessment. It usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains by emphasizing functional capacity and quality of life and, often, by incorporating a multidisciplinary team. The geriatric assessment aids in the diagnosis of medical conditions development of treatment and follow-up plans coordination of management of care and evaluation of long-term care needs and optimal placement. Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance. It is usually initiated when the physician identifies a potential problem. The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances.
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