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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #11, #14, #21, #22, #25, #26, #37, #45, #52, #56, #69, #72

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LEARNING OBJECTIVES

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Learning Objectives

  • To distinguish between geriatric assessment and comprehensive geriatric assessment

  • To identify the core components of geriatric assessment by individual clinicians

  • To learn practical approaches to geriatric assessment that can be administered within the constraints of a busy office practice

  • To understand the core components of comprehensive geriatric assessment

  • To know the evidence-based strengths and limitations of comprehensive geriatric assessment

  • To recognize how some important components of comprehensive geriatric assessment have been integrated into new health care innovations

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Key Clinical Points

  1. Geriatric assessment extends beyond the traditional disease-oriented medical evaluation of older persons’ health to include assessment of cognitive, affective, functional, social, economic, environmental, and spiritual status, as well as a discussion of patient preferences regarding advance directives.

  2. Observing patients walking and performing balance maneuvers best assesses balance and gait disorders. Qualitative gait assessment can be performed while the patient is entering or leaving the examining room and can be augmented by measuring gait speed. Patients who take more than 13 seconds to walk 10 m are more likely to have recurrent falls.

  3. Although in 2014, the US Preventive Services Task Force (USPSTF) concluded that there is insufficient evidence on the balance of benefits and harms of screening for cognitive impairment, clinicians should assess cognition when there is suspicion of impairment.

  4. Much of the germane information of the medical history can be obtained from old records, other professional or nonprofessional staff, or by self-report from patients or family members completing forms.

  5. By delegating the administration of screening instruments for many of the important geriatric problems to trained office staff, the clinician may spend a short period of time reviewing the results of these screens and then decide which dimensions, if any, need greater evaluation.

  6. In virtually all studies of comprehensive geriatric assessment, the process itself has resulted in improved detection and documentation of geriatric problems. However, such identification of problems has not always led to improved outcomes.

  7. The best evidence for effectiveness of comprehensive geriatric assessment is for inpatient geriatric units and home assessments of younger-geriatric patients.

  8. Concepts of comprehensive geriatric assessment have been incorporated into new successful models of care (eg, Geriatric Resources for Assessment and Care of Elders [GRACE] and Guided Care), specialty care, and disease management programs.

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Geriatric assessment is a broad term used to describe the health evaluation of older patients, which emphasizes components and outcomes different from that of the standard medical evaluation. This approach recognizes that the health status of older persons is dependent on influences beyond the manifestations of their medical conditions. Among these are social, psychological and mental health, and environmental factors. Geriatric assessment also places high value on functional status, both as a dimension to be evaluated and as an ...

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