Geriatric assessment is a broad term that describes a clinical approach to older patients that goes beyond a traditional medical history and physical exam to include functional, psychological, and social domains that affect well-being and quality of life. As an organizational framework, a geriatric scaffold (Figure 2–1) can help a clinician visualize how these domains are often connecting and overlapping. The scaffold is organized into three main outcomes of the geriatric assessment: prognosis, goals of care, and functional status. Functional status encompasses the effects of the core elements of the geriatric patient’s health, including medical, cognitive, psychological, social, and communications barriers. This chapter will outline the geriatric assessment via the scaffold, its three main outcomes, and the core elements that contribute. We will also address how the geriatric assessment may be influenced by the clinical site of care.
Geriatric scaffold. ADLs, activities of daily living; IADLs, instrumental activities of daily living.
TEAMS AND CLINICAL SITES OF CARE
Although geriatric assessment may be comprehensive and involve multiple team members (eg, social workers, nurses, physicians, rehabilitation therapists, pharmacists), it may also involve just a single clinician and be much simpler in approach. In general, teams that use an interprofessional approach, in which multiple professions work together to develop a single comprehensive treatment plan for a patient, are most common in settings that serve primarily frail, complex patients, such as inpatient units, rehabilitation units, Program for All-Inclusive Care of the Elderly (PACE) sites, and long-term care facilities. In outpatient settings, teams are less likely to be formalized and, if present, are more likely to be virtual, asynchronous, and multidisciplinary (teams in which each discipline develops its own assessment and treatment plan) than interprofessional. (For more information, see Chapter 3, “The Interprofessional Team.”)
Regardless of team composition, the setting and functional level of the patient population being served will determine what assessment tools are most appropriate. For example, long-term care settings are likely to focus on basic activities of daily living (ADLs), such as bathing, whereas outpatient teams are more likely to focus on higher levels of functioning, such as mobility and ability to prepare meals. In inpatient settings, the focus is on preventing deconditioning; providing medical support, such as nutrition; and planning discharge, including assessing rehabilitation potential and the best setting for discharge. Regardless of the team structure, site, and tools being used, many of the principles of geriatric assessment are the same.
An older adult’s prognosis is important in determining which interventions are likely to be beneficial or burdensome for that individual. In community-dwelling older persons, prognosis can be estimated initially by using life tables that consider the patient’s age, gender, and general health. When an older patient’s clinical situation is dominated by ...