Unique Features of the Elderly Patient RAMPS R- reduced body reserve A- atypical presentation M- multiple pathology P- polypharmacy S- social adversity
Geriatric Assessment a Physical a Mental a Functional status a Social status
Physical Assessment a History taking a chief complaint a history of present illness a past medical history a family history a drug history
History taking 1)History of fall, incontinence 2)Pain assessment 3)Drug history: polypharmacy! 4)Nutritional history 5)Life-style: smoke, drink, exercise, aids & appliances 6)Vaccinations : influenza, tetanus, pneumococcal ?
History taking a cognitive impairment, look for relatives a not respond to verbal command: 3 D’s : dysphasia, depression, deafness. a adequate exposure but no direct light a private place with minimal distraction a face to face with slow and clear conversation a use aids and appliances, if necessary a use “yes” or “no” in motor aphasia a need more time than the young a multiple pathology rather than one disease a nutritional assessment: dietary recall, MNA
History taking a Past medical history: only major illness leading to admission or absence from work Chronic illness: atherosclerosis (DM, HT, ischemic heart disease, cerebrovascular disorder, dyslipidemia), TB, osteoarthritis a Personal history: smoking, alcohol drinking a Family history : family member and status a Drug history : polypharmacy, eye drop, skin preparation, over-the-counter drugs a Systemic review: geriatric syndrome
Abbreviated Mental Test a Age a Time a Address a Year a Name of institution a Recognition of two persons a Date of birth a Year of first world war a Name of present monarch a Count backwards 20 to 1
Screening for depression In practice: ask 2 questions Over the past 2 weeks, have you felt down, depressed, or hopeless? Over the past 2 weeks, have you felt little interest or pleasure in doing things? If “yes” for both questions, proceed to Thai Geriatric Depression Scale