Geriatrics - Basic Tools

82 yo lady comes to your office because her daughter thinks that her mother has become a little forgetful. She feels fine although she sometimes forgets to take her pills.
"How often do you forget to take them?" you ask.
"Well, once a week...probably 3 times per week...may be every other day..." she answers.

How will you evaluate this patient?

First, it is important to establish a baseline.

That's why we ask about the ADL/IADL. You can use the mnemonic DEATH SHAFT.
DEATH SHAFT stands for:
D ressing
E ating
A mbulation
T oilet
H ygiene

S hopping
H ousekeeping
A ccounting ~ finances
F ood preparation-> who’s cooking?
T ransportation -> driving?

Do not forget to evaluate for the 4 geriatric "giants" - III-C.
III-C stands for:
I ncontinence
I mmobilization
I nstability-> falls
C onfusion

Print out and do the MMSE. Don't forget that some patients will try to fool you with the MMSE - they simply try to convince you that they don't need the test or that doing it is just stupid. There is a fascinating story in BMJ about a demented lady who "revised for" the MMSE each month - Beating the test, BMJ 10/2004. Palm owners can download the dTree MMSE program for free.


Resources:
Geriatric Web by the University of South Carolina

University of Iowa has a wonderful geriatrics website with all sorts of tools that you can download and use like MMSE, Geriatric Depression Scale, Geriatric Health Questionnaire, Instrumental Activities of Daily Living.

Merck Manual of Geriatrics is another useful resource available online for free. They also provide educational toolkits for managing of common symptoms in the elderly.

See a get-up-and-go test as a video file from KUMC website.

Geriatrics At Your Fingertips
Geriatrics At Your Fingertips is a free PDA program provided by the American Geriatrics Society. It works on both Palm and PocketPC and according to Dr. Sawhney (a former SVCH chief resident, now a HemOnc fellow at UCLA), it is pretty good. You have to register to use this service.

Quote:
"Turning Eighty - A Birthday Poem: It is a breath-taking near-death experience"
by David Ferry, Slate 12/04

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