Functional Assessment, Geriatrics focus

Describe the importance of functional abilities in health care assessment.

 * Geriatrics focuses not just on keeping a patient well and solving their medical problem. It looks at the patient from a holistic perspective and focuses on how to keep a patient active, independent, and psychologically stable.  This is a shared responsibility with the patient, the doctor, and the family.

Describe the limits of the standard history and physical in detecting functional deficits.

 * The standard history and physical isn't very sensitive in picking up change in IADLs and ADLs (defined below).
 * Well spoken individuals can mask the problems that they are having at home with conversation, unless specifically asked about discrete tasks.
 * Decline can be slow and progressive, so a numerical scale can provide the perspective that is needed to identify these issues.
 * A quick visit may ignore these important issues, as they are not thought of in the standard younger person history and physical.

Describe the components of Activities of Daily Living (ADL).

 * Activities of Daily Living (ADLs)
 * A survey of activities require of adults to be independence. Includes:


 * Bathing
 * Dressing
 * Toileting
 * Transfer (move in and out of bed, chairs, etc)
 * Continence
 * Feeding (without assistance)

Describe the components of IADL and discriminate between these and "ADL" activities.

 * Instrumental Activities of Daily Living (IADL)'s
 * Used with active members of the community to evaluate a patient's self sufficiency at home. Includes:


 * telephone usage
 * balancing checkbook
 * preparing one's own meals
 * shopping for groceries
 * taking medications w/o help
 * laundry, housework, etc

Get up and Go Test

 * The “Get Up and Go Test” is an assessment that should be conducted as part of a routine evaluation when dealing with older persons. Its purpose is to detect “fallers” and to identify those who need evaluation.
 * All older persons who report a single fall should be observed as they:
 * 1) From a sitting position, stand without using their arms for support.
 * 2) Walk several paces, turn, and return to the chair.
 * 3) Sit back in the chair without using their arms for support.

Romberg Test

 * A Positive Romberg test, indicates loss of proprioception. The action starts at (0:24 seconds).


 * Ask the patient to stand with their feet together (touching each other). Then ask the patient to close their eyes. Remain close at hand in case the patient begins to sway or fall.

Describe the movement components of "gait."

 * Neuroexam.com on Gait - a Yale Neurologist's teaching site. Great description of Gait in 200 words.