Office-based assessment of the older adult
- David B Reuben, MD
David B Reuben, MD
- Director, Multicampus Program in Geriatric Medicine and Gerontology
- Archstone Professor of Medicine
- David Geffen School of Medicine at UCLA
- Susan D Leonard, MD
Susan D Leonard, MD
- Assistant Clinical Professor, Division of Geriatric Medicine
- UCLA Department of Medicine
Today's individuals are living longer compared to prior generations. The goals for most older persons are to survive and thrive, although usually with medical conditions and impairments in their abilities to perform physical and social tasks, commonly referred to as functional status.
This topic will discuss an approach to assessment of the older adult being seen in the generalist's office, including the domains of assessment and a practical approach to performing the assessment. The more formal interdisciplinary comprehensive geriatric assessment, appropriate for selected patients with specific geriatric concerns, an approach to health maintenance in the geriatric population, and management of multiple morbidity in older adults are discussed separately. (See "Comprehensive geriatric assessment" and "Geriatric health maintenance" and "Managing multiple comorbidities".)
PRINCIPLES OF ASSESSMENT OF THE OLDER PATIENT
Geriatric assessment recognizes the multidimensionality of contributors to health and function and can provide key diagnostic insights into the health of the older patient. Assessments of particular importance in older persons include:
●Hearing (see "Evaluation of hearing loss in adults")
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- PRINCIPLES OF ASSESSMENT OF THE OLDER PATIENT
- FUNCTIONAL ASSESSMENT
- Rationale for assessing functional status
- Components of functional status
- - Basic ADLs
- - Instrumental ADLs
- - Advanced activities of daily living
- - Assessing functional status
- MOBILITY ASSESSMENT
- Qualitative gait assessment
- Gait speed
- Muscle strength
- Fall risk and assessment
- Life-space assessment
- SOCIAL AND ENVIRONMENTAL ASSESSMENT
- Taking a social history
- Available support services
- Residential options for independent living
- Options for residential facilities
- ASSESSMENT OF PROGNOSIS AND PATIENT GOALS
- Patient goals
- MULTIDIMENSIONAL ASSESSMENT INSTRUMENTS
- A PRACTICAL APPROACH TO GERIATRIC ASSESSMENT IN OFFICE SETTINGS
- SUMMARY AND RECOMMENDATIONS