Assessment in

Geriatric patients

Objectives
1. Evaluate the functional status of elderly patients.
2. Lists each examples each of ADLs and IADLs (e.g.
Barthel index).
3. Identify barriers to maintaining function and the ability
to perform activities of daily living (ADLs) and
instrumental activities of daily living (IADLs).
4. Plan patient-centered care which meet the physical,
emotional, spiritual, cultural and social needs and
expectations of the geriatric patient

Introduction
The population of Malaysia is aging.
By 2021, the population aged 65 years and over is
expected to reach 7.1 per cent. (
Population Projection, Malaysia 2010 - 2040 )
Geriatric conditions such as functional impairment and
dementia are common and frequently unrecognized or
inadequately addressed in older adults.
Identifying geriatric conditions by performing a geriatric
assessment can help clinicians manage these conditions
and prevent or delay their complications.

Background
Comprehensive geriatric assessment (CGA) is defined
as a multidisciplinary diagnostic and treatment process
that identifies medical, psychosocial, and functional
limitations of a frail older person in order to develop a
coordinated plan to maximize overall health with aging.
It requires evaluation of multiple issues including
physical, cognitive, affective, social, financial,
environmental, and spiritual components that influence
an older adult's health.

 The geriatric assessment differs from a typical medical

evaluation by including nonmedical domains; by emphasizing
functional capacity and quality of life; and, often, by
incorporating a multidisciplinary team including a physician,
nutritionist, social worker, and physical and occupational
therapists.
This type of assessment often yields a more complete and
relevant list of medical problems, functional problems, and
psychosocial issues.
Deficits in ADL and IADL can signal the need for more in-depth
evaluation of the patient's socioenvironmental circumstances and
the need for additional assistance.

Prevalence
Approximately 75% of persons over age 75 limit their
activities due to functional impairment each year.
Almost 50% of people 85 years of age and older require
assistance in one or more ADL.
As many as 25% of older community-dwelling adults
have at least one impairment in IADLs.
Among patient admitted to general medical hospital
units, 40% have at least one ADL impairment, 65% have
one or more IADL, and 30% have mobility impairment.

Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan Medical School, 2003

Clinical Implications
ADL impairment is a stronger predictor of hospital outcomes
(functional decline, length of stay, institutionalization, and death).
ADL impairment is also a risk factor for nursing home placement,
emergency room visits, and death among community-dwelling
adults.
Approximately 25% to 35% of older patients admitted to the
hospital for treatment of acute medical illness lose independence
in one or more ADL.
Risk factors for loss of independence in ADLs during
hospitalization include advanced age, cognitive impairment, and
IADL impairments at admission.
Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of Functional Measures in Predicting Mortality Among Older Hospitalized Patients.JAMA.1998;279(15):1187-1193.
doi:10.1001/jama.279.15.1187.
Thomas M. GillandBrenda F. KurlandPrognostic Effect of Prior Disability Episodes among Nondisabled Community-living Older PersonsAm.J.Epidemiol.(2003)158(11):10901096doi:10.1093/aje/kwg237

Comprehensive geriatric
assessment (CGA)
MAJOR COMPONENTS
Core components of that should be evaluated during the
assessment process are as follows:

ADDITIONAL COMPONENTS

Functional capacity

Additional components may also include evaluation of the

following:

Fall risk (Seminar 2)

Nutrition/weightchange

Cognition (seminar 3)

Urinary continence

Mood (Seminar 3)

Sexual function

Polypharmacy (lecture 2)

Vision/hearing

Social support (seminar 4)

Dentition

Financial concerns (seminar 4)

Living situation

Goals of care (seminar 4

Spirituality

Advanced care preferences (seminar 4)

Assessing Patients Functional

Status
Definition: Functional status refers to a persons ability
to perform tasks that are required for living.
The geriatric assessment begins with a review of the two
key divisions of functional ability: activities of daily living
(ADL) and instrumental activities of daily living (IADL).

ADL are self-care activities that a person performs daily.

Instruments for assessing ADL - Katz ADL scale

IADL are activities that are needed to live independently.

Instruments for assessing IADL - Lawton IADL scale

Assessment Tools - Functional

impairment
Ask: Do you have difficulty or require assistance with
any of the following?