GLOBAL GERIATRIC ASSESSMENT

Health assessment of older adults can be done on several levels, ranging from simple screenings to complex, in-depth evaluations. To perform assessments accurately, nurses and other health care providers who gather information regarding older adults must possess the necessary knowledge and skill to perform the assessment correctly.

PHYSICAL ASSESSMENT

Before starting a physical assessment, the nurse will use interviewing techniques to obtain a health history.

Obtain the health history:

In the elderly, there are factors that hinder the clinical interview and make it more difficult

The nurse must be aware of these limitations:

• Communication
• Vague description of symptoms
• Multiple complaints

Identifying data:

• Name
• Date of birth
• Residence
• Marital/significant other status
• Previous and/ or current occupation

Past history:

• Perfection of general health
• Frequency of medical and dental care, including screenings
• Immunizations
• History of serious illnesses
• Hospitalizations
• Surgeries

Present medical history:

• Major current problems or concerns
• Symptoms
• Date of onset
• Medications currently taken

Family and psychosocial history:

• Living family members and nature relationships
• Friends and social activity practices
• Hobbies and interests

Mini Nutricional Assessment

Inspection: is the most commonly used method of physical assessment in with the senses of vision, smell and hearing are used to collect data.

Palpation uses the sense of touch in the fingers and hands to obtain data. Is used for evaluation pulses, temperature and texture of the skin…

Auscultation

Percusision

Assessing vital signs: temperature, pulse, respiration, blood pressure..

Body systems approach to physical assessment:

• Skin: colour, pigment, temperature, lesions, edema
• Nails: shape, color, thickness
• Hair: color and texture, distribution
• Skull, face and neck
• Eyes: check size of pupils
• Ears
• Respiration: shape of torax, spinal curvatures, rate and ryth, of respiration
• Cardiovascular
• Gastrointestinal
• Musculoskeletal
• Neurologyc
• Genitourinary

VALUATION OF FUNCTIONAL AREA

When progresses the degree of functional impairment increases:

• The number of hospital admissions and length of stay
• Medical visits
• The consumption of drugs
• The risk of institutionalization
• Social resource requirements

Scales used to assess AVDB:

• Index of Activities of Daily Living (Katz):
• Barthel Index
• Physical Disability Scale of Red Cross
• Plutchik Scale

Scales used to assess AVDI:

• Lawton and Brody index

When exploring the cognitive sphere, we must question about:

• School-level, profession
• Presence of cardiovascular risk factors (hypertension, diabetes, atrial fibrillation)
• Family history of dementia
• Psychiatric background
• Consumption of drugs and toxic
• Complaint, a start and progression of symptoms
• Guidance
• Complaints of memory impairment
• Problems in recognition of family and friends.
• Language
• Capacity for abstraction / trial
• Conduct disorders

SHORT PORTABLE MENTAL STATUS DE PFEIFFER (SPMSQ)

MINI-MENTAL STATE EXAMINATIO DE FOLSTEIN (MMSE)

The anxiety and depression, major affective symptoms in old age and is an emotional state of uneasiness and apprehension disproportionate to the stimulus that triggers it. It has an impact on life quality, performance on cognitive functions, exacerbates depressive and physical discomfort.

To assess the affective sphere, we have:

• Scale of Yesavage Geriatric Depression
• Hamilton Depression Inventory
• Beck Depression Inventory
• Scale of Zung
• Cornell Scale of Depression in Dementia
• Anxiety and Depression Scale of Goldberg

I think we should pay attention to the patient since the moment he coming in.

Communication with the patient must be clear and we must speak loud for he listen us well.

A good global assessment is important to detect problems quickly.

Gloria Hoffmann Wold. Basic Geriatric Nursing. 5^th ed. Milwaukee, Wisconsin:Elsevier; 2012