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Файл:Comprehensive geriatric assessment from theory to practice. Study aid
.pdf
101
Physical examination data
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Height (cm)
Shoulder circumference
(cm)
Weight, kg)
Forearm circumference
(cm)
BMI (kg/m²)
Hip circumference (cm)
Waist
circumference
(cm)
Calf circumference (cm)
BP, Ps initially (sitting)
BP, Ps after 7 minutes in a
horizontal position
BP, Ps after the transition to a
vertical position
within 1 minute
within 3 minutes
Dynamometry (kg)
1 try
2 try
right hand
left hand
Walking speed (m/s)
Get up and go test
Ability to maintain balance (sec)
On the right leg
On the left leg
102
Mental Status Assessment Scale (MMSE)
Parameter
Points
1. Orientation in time (ask the patient to indicate the day, month,
year, day of the week, season
/5
2. Orientation in place: ask the patient to tell where he is? (country,
region, city, clinic, floor)
/5
3.Immediate playback: ask the patient to repeat:
pencil, house, penny
/3
4. Attention concentration and counting: ask the patient to subtract
7 from 100 5 times in succession (or say the word “earth” in reverse)
100 – 7 = 93; 93 – 7 = 86; 86 – 7 = 79; 79 – 7 = 72; 72 – 7 = 65;
/5
5. Delayed recall: ask the patient to recall the 3 items named during
the immediate recall test pencil, house, penny
/3
6. Speech and performance of actions: We show a pen and a watch,
we ask: “What is it called?”
/2
7. Please repeat the sentence: “No ifs, and or buts”
/1
8. Ask the patient to perform a sequence of 3 actions:
“Take a sheet of paper with your right hand, fold it in half and put it
on the floor”
/3
9. Write on a piece of paper “Close your eyes”, show the patient and
ask him to do what he read
/1
10. Ask the patient to write a sentence (the sentence must have a
subject and a predicate, it must make sense)
/1
11. Ask the patient to copy the drawing
/1
Total score
CLOSE YOUR EYES
103
Geriatric Depression Scale
1
In general, are you satisfied with your life?
NO
2
Have you abandoned most of your activities and
interests?
YES
3
Do you feel like your life is empty?
YES
4
Do you often get bored?
YES
5
Are you in a good mood most of the time?
NO
6
Are you afraid that something bad will happen to you?
YES
7
Do you feel happy most of the time?
NO
8
Are you feeling helpless?
YES
9
Do you prefer to stay at home than go out and do
something new?
YES
10
Do you think that your memory is worse than others?
YES
11
Do you think that life is wonderful?
NO
12
Do you feel useless now?
YES
13
Do you feel full of energy and vitality?
NO
14
Do you feel the hopelessness of the situation you are in
right now?
YES
15
Do you think that the people around you live a more
fulfilling life compared to you?
YES
Total score:
/15
1 point is credited for the answer “no” to questions 1, 5, 7, 11, 13 and
for answering “yes” to questions 2, 3, 4, 6, 8, 9, 10, 12, 14, 15.
Basic activity scale in daily life (Bartel index) — ADL
Meal
10 — does not need help, is able to independently use all
the necessary cutlery;
5 — partially needs help, for example, when cutting food;
0 — completely dependent on others (needs feeding with
assistance)
Personal hygiene
(washing, brushing teeth,
shaving, combing)
5 — does not need help;
0 — needs help
104
Dressing
10 — does not need outside help;
5 — partially needs help, for example, with putting on
shoes, fastening buttons, etc.;
0 — completely in need of assistance
Bathing
5 — takes a bath without assistance;
0 — needs outside help
Toilet visits: moving
around the toilet,
undressing, cleaning the
skin, dressing, exiting
the toilet
10 — does not need help;
5 — partially needs help (maintaining balance, using toilet
paper, taking off and putting on trousers, etc.);
0 — needs to use ship, duck
Urination control
10 — full control;
5 — random incidents (maximum 1 time in 24 hours);
0 — incontinence
Defecation control
10 — full control;
5 — random incidents (no more than one per week)
0 — incontinence
Moving from bed to
chair and back
15 — does not need help;
10 — when getting out of bed, little help or supervision is
required;
5 — when getting out of bed, assistance is required, can
sit in bed on his own;
0 — movement is not possible
Climbing stairs
10 — does not need help;
5 — needs supervision or support;
0 — unable to climb stairs even with support
Mobility (moving within
and outside the home;
assistive devices may be
used)
15 — does not need help;
10 — can walk with assistance;
5 — can move with the help of a wheelchair;
0 — not capable
Total score:
/100
105
Daily Instrumental Activity Scale (IADL)
3 points — without outside help; 2 points — with partial help;
1 point — completely unable/
1. Can you use the phone?
/3
2. Can you get to places that are outside the normal walking distances?
/3
3. Can you go shopping for food?
/3
4. Can you cook your own food?
/3
5. Can you do housework?
/3
6. Can you do small “male”/”female” housework?
/3
7.Can you wash for yourself?
/3
8. Can you self-medicate?
/3
9. Can you manage your money?
/3
Total score:
/27
Ability to perform basic functions
2 points — maybe; 1 point — with difficulty; 0 points — can't.
Put your hands behind your head, behind your back at waist level
/2
Sitting, touch the big toe on the opposite leg with your hand
/2
Squeeze doctor's fingers with both hands
/2
Hold a piece of paper between your thumb and forefinger
/2
Get up from a chair without using your hands
/2
Total score:
/10
Brief Scale Nutritional Assessment (MNA)
A.
Has the amount of food you eat decreased in the
past 3 months due to loss of appetite, digestive
problems, difficulty chewing or swallowing?
0 = severe reduction in food
intake
1 = moderate reduction in the
amount of food eaten;
2 = no reduction in food
intake
106
B.
Weight loss in the last 3 months
1= don't know;
2 = m body loss from 1
to 3 kg
3 = no weight loss
C.
Mobility
0 = chained to bed/chair;
1 = able to get out of
bed/chair but does not leave
the house;
2 = leaves home
D.
Acute illness (psychological stress) in the last 3
months
0 = yes;
2 = no
E.
Psychoneurological problems
0 = severe memory
impairment or depression;
1 = moderate memory
impairment;
2 = no neuropsychological
problems
F.
Body mass index
0 = less than 19;
1 = 19–21;
2 = 21–23;
3 = 23 and above
G.
Lives independently (not in a nursing home or
hospital)
0 = no; 1 = yes
H.
Takes more than three medications a day
0 = yes; 1 = no
I.
Pressure sores and skin ulcers
0 = yes; 1 = no
J.
How many times a day does the patient eat
well?
0 = 1 time; 1 = 2 times;
2 = 3 times
K.
Protein intake markers:
0 = if 0–1 the answer is yes;
0.5 = if 2 answers are yes;
1 = if 3 answers are yes
one serving of dairy products (1 serving =
1 glass of milk, 60 grams of cottage cheese, 30
grams of cheese, 3/4 cups of yogurt) per day
(yes / no);
two or more servings of legumes and eggs per
week (1 serving = 200 grams of legumes, 1 egg)
(yes/no);
meat, fish or poultry every day (yes/no)
107
L.
Eats two or more servings of fruits or vegetables
per day (1 serving = 200 grams of vegetables, 1
medium sized fruit of any kind)
0 = no; 1 = yes
M.
How much liquid does he drink per day
0 = less than 3 glasses;
0.5 = 3–5 glasses; 1 = more
than 5 glasses
N.
Feeding method
0 = unable to eat without
assistance;
1 = on my own with little
difficulty
2 = self
O.
Self-reported nutritional status
0 = rates self as malnourished;
1 = rates own nutritional
status indefinitely;
2 = rates self as having no
nutritional problems
P.
Health status compared to other people of the
same age
0 = not so good
0.5 = don't know;
1 = same good;
2 = better
Q.
Circumference in the middle of the shoulder, cm
0 = less than 21;
0.5 = 21–22;
1 = 22 and more
R.
Calf circumference, cm
0 = less than 31;
1 = 31 and more
Total score:
/30
Insomnia Severity Index (ISI)
For each item, circle the number that best matches your answer.
Please rate your CURRENT (that is, in the past 2 weeks) sleep
problems:
Sleep problem
Not
Light
Moderate
Heavy
Very
heavy
1. Trouble falling
asleep
0 1 2 3 4
108
Sleep problem
Not
Light
Moderate
Heavy
Very
heavy
2. The problem of
intermittent sleep
0 1 2 3 4
3. The problem of
waking up too early
0 1 2 3 4
4. How satisfied (or dissatisfied) are you with your sleep?
Very satisfied
Satisfied
Relatively
satisfied
Not satisfied
Very
dissatisfied
0 1 2 3 4
5. How NOTICEABLE do you think your sleep problems are to
others? In terms of your quality of life?
Not noticeable
at all
Slightly
noticeable
A little
noticeable
Highly visible
Very much
visible
0 1 2 3 4
6. To what extent are you CONCERNED (concerned) by your
current sleep problems?
Not worried
at all
A little
worried
A little
worried
Very
disturbed
Very much
worried
0 1 2 3 4
7. To what extent do you think your sleep problems INTERFERE
with your daily functioning (affect, for example, in the form of daily
fatigue, ability to perform work/daily duties, concentration, memory,
mood, etc.) CURRENTLY?
Doesn't
interfere at all
A little
interfere
Interfere a
little
Strongly
interfere
They interfere
very much
0 1 2 3 4
109
Interpretation of the results: 0–7 points in total — the norm; 8–14 —
mild sleep disturbances; 15–21 — moderate; 22–28 — pronounced.
Visual analog scale of self-assessment of health status
0 % 100 %
Diagnosis of delirium
1
Passport part
1.1/2/3
/4/5/6/
receipt date
__/__/____
department
No. IB
Date of filling
out the
questionnaire
__/__/____
Time____
Date of
operation
__/__/___
_
Days of
the
postoperat
ive period
___
1.7
Operation name
1.8
Diagnosis at admission
Basic____
Complications_____
Related ________
1.9/10
Hospitalization
planned ____
emergency____
emergency hospitalization
SMP machine ___
transfer from other medical
institutions/departments_____
When self-referencing ______
110
2
Anamnesis
2.1/2/3
Transient ischemic attacks
__ no ___ / ___ yes ___
Strokes
__no___/___yes___
ischemic ____
hemorrhagic ____
Prior Cognitive
Impairments
2.4
Vision assessment
according to the Rosenbaum
table
Right eye_____
Left eye______
3
Previous and current drug history
3.1/2
Names of drugs used at the time of admission / route of
administration
Indications
3.3/4
Names of drugs at the time of examination / including
days of admission to the hospital / parenterally
Indications
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