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Файл:Comprehensive geriatric assessment from theory to practice. Study aid
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71
Row
number
Symptoms of depression
4
Early insomnia
0 = no difficulty falling asleep;
1 = complaints of episodic difficulty falling asleep (longer than
30 minutes);
2 = complaining about not being able to sleep every night
5
Average insomnia
0 = not available;
1 = complaints of restless sleep throughout the night;
2 = multiple awakenings throughout the night — any getting out of bed
is scored as a “2” (excluding physiological needs).
6
late insomnia
0 = not available;
1 = early morning awakening followed by sleep;
2 = final early morning awakening
7
Efficiency and activity
0 = no difficulty;
1 = thoughts and feelings of failure, feeling tired and weak associated
with activities (work or hobbies);
2 = loss of interest in activities (work or hobbies), expressed directly
in complaints or indirectly, through apathy and indecision (feeling of
the need for additional effort to start work or be active);
3 = decrease in real time of manifestation of activity or decrease in
productivity; in a hospital setting, a score of “3” is given if the patient's
activity is manifested for at least 3 hours a day (work in a hospital or
hobby);
4 = refusal to work due to present illness; in a hospital, a score of
“4” is given if the patient is not active at all or cannot even cope with
routine household activities without outside help.
8
Lethargy (slow thinking and speech, impaired ability to concentrate,
decreased motor activity)
0 = normal speech and thinking;
1 = slight retardation in conversation;
2 = marked slowness in conversation;
3 = severe difficulty in interviewing;
4 = complete stupor
72
Row
number
Symptoms of depression
9
Agitation (alarming)
0 = no;
1 = anxiety;
2 = restless hand movements, hair pulling, etc.;
3 = mobility, restlessness;
4 = constant fingering, nail biting, hair pulling, lip biting.
10
Мental anxiety
0 = not available;
1 = subjective tension and irritability;
2 = anxiety for minor reasons;
3 = anxiety reflected in facial expression and speech;
4 = fear expressed without questioning
11
Somatic anxiety (physiological manifestations of anxiety:
gastrointestinal — dry mouth, flatulence, dyspepsia, diarrhea, spasms,
belching; cardiovascular — palpitations, headaches; respiratory —
hyperventilation, shortness of breath, frequent urination; increased
sweating).
0 = no;
1 = weak;
2 = medium;
3 = strong;
4 = extremely strong
12
Gastrointestinal somatic symptoms
0 = no;
1 = loss of appetite, but eating without strong compulsion; feeling of
heaviness in the abdomen;
2 = eating only with persistent compulsion; need for laxatives or drugs
to relieve gastrointestinal symptoms
13
General somatic symptoms
0 = no;
1 = heaviness in the limbs, back or head, muscle pain; feeling of loss
of energy or loss of strength;
2 = any severe symptoms
14
Genital symptoms (loss of libido, menstrual irregularities)
0 = no symptoms;
1 = mild;
2 = strongly pronounced
73
Row
number
Symptoms of depression
15
Hypochondria
0 = no;
1 = self-absorption (bodily);
2 = excessive health concern;
3 = frequent complaints, asking for help, etc.;
4 = hypochondriacal delusions.
16A
Weight loss (either item A or B is assessed)
A. According to the anamnesis:
0 = no weight loss;
1 = probable weight loss due to present illness;
2 = apparent (according to the patient) weight loss;
3 = not assessable
16B
B. If weight changes occur on a weekly basis
0 = weight loss less than 0.5 kg per week;
1 = more than 0.5 kg per week;
2 = more than 1 kg per week;
3 = not assessable
17
Critical attitude towards the disease
0 = awareness that he is ill with depression or some kind of disease;
1 = awareness of the morbidity of the condition, but attributing this to bad
food, climate, overwork at work, viral infection, need for rest, etc.;
2 = complete lack of awareness of the disease
18A
Daily fluctuations
A. Specify when the symptoms are more severe, morning or evening;
if there are no daily fluctuations, mark 0 points
0 = no oscillation;
1 = worse in the morning;
2 = worse in the evening
18B
B. If there are daily fluctuations, evaluate their severity; in the absence
of hesitation, mark the item “absent”
0 = none;
1 = weak;
2 = strong
74
Row
number
Symptoms of depression
19
Depersonalization and derealization (for example, feeling the unreality
of the environment)
0 = not available;
1 = weak;
2 = moderate;
3 = strong;
4 = intolerable
20
Рaranoid symptoms
0 = none;
1 = suspicious;
2 = ideas of relation;
3 = delusions of relationship and persecution
21
Obsessional and compulsive symptoms
0 = none;
1 = lungs;
2 = heavy
Score: 0–6 — no depressive episode, 7–15 — minor depressive
episode, 16 or higher — major depressive episode.
It should be borne in mind that the GDS-30 score itself only indicates
the presence of symptoms of depression, however, is by no means a basis
for diagnosing depression of late age. The obtained high scores on the
GDS-30 and the analysis of the completed protocol allow the specialist to
single out only targets for further analysis of the mental status. This is just
an excuse to carefully question the elderly patient about his internal state,
to observe his behavior, to arrange a thorough questioning of relatives
about the patient's condition.
It is recommended to pay attention to the first question, assessing life
satisfaction, since it has a high predictive value in diagnosing symptoms of
depression in later ages. Forms of the Geriatric Depression Scale can also
be used.
Of 15, 5 and 4 questions to conduct a screening assessment of the
mental state of an elderly patient.
75
Geriatric Depression Scale
Instructions: You are offered a form that contains 30 questions. Each
question should be answered with either “yes” or “no”.
QUESTIONNAIRE:
1. Are you satisfied with your life?_____
2. Have you often had to give up your business or interests?_____
3. Do you feel like your life is empty?_____
4. Do you often get bored?_____
5. Do you have hopes for the future?_____
6. Do you have thoughts that you can't get rid of?_____
7. Do you spend most of your time in a good mood?_____
8. Are you afraid that something bad might happen to you?______
9. Do you feel happy most of the time?_____
10. Do you often feel helpless?_____
11. Do you often feel anxious?_____
12. Do you prefer to stay at home at night than to go outside for new
sensations?_____
13. Do you often worry about your future?______
14. You feel like you have more memory problems than most other
people?_____
15. Do you think it's good to be alive now?_____
16. Do you often feel sad, depressed?_____
17. Do you feel concerned about how you live now?_____
18. Are you very worried about your past? _____
19. Do you find life exciting for you?_____
20. Are new beginnings difficult for you?_____
21. Do you feel full of energy?_____
22. Do you feel that your situation is hopeless?_____
23. Do you feel like most people are better than you?_____
24. Do you often get upset over little things?_____
25. Do you often feel like crying?_____
26. Do you have trouble concentrating?_____
76
27. Do you enjoy waking up in the morning?_____
28. Do you prefer to avoid social gatherings?_____
29. Do you find it easy to make decisions?_____
30. Is your mind as clear as it usually is?_____
Key: depressive responses include
Answers “yes” to questions: 2, 3, 4, 6, 8, 10, 11, 13, 14, 16, 17, 18,
20, 22, 23, 24, 25, 26, 28.
Answers “no” to questions: 1, 5, 7, 9, 12, 15, 19, 21, 27, 29, 30.
More than 10 “depressive” responses = positive depression test.
For rate subjective feelings of loneliness the California Loneliness
Scale (abbr. R-UCLA-LS) is used, which assesses the emotional and social
component of loneliness. The results obtained on this scale make it
possible to predict the development of a wide range of mental disorders
(episodes of depression, anxiety disorder) and psychosocial problems that
affect health in old age.
77
6. ASSESSMENT OF MOTOR ACTIVITY
IN ELDERLY AND SENILE PEOPLE
Table 6
Scale for assessing functional activity in everyday life
Yes
Not
Bathing (sponging,
bathing or showering)
No assistance required or assistance
needed when washing any one part of
the body
Dressing
Takes clothes and dresses without help
other than putting on shoes
Visiting the toilet
Goes to the bathroom, uses the toilet,
manages with clothes, and returns
unaided (may use a stick or walker for
support and may use a vessel or urinary
catheter at night)
Move around the
room
Lies down and sits up, gets out of bed
and chair without help (can use a stick
or walker)
Ability to control
urination and
defecation
Completely and independently controls
the function of the intestines and
bladder (there is not even episodic
cases of incontinence)
Food
Eating by yourself (excluding helping
cut meat or spread butter on bread)
Amount (number of “YES” answers out of six possible)
(Modification S.Katzetal scales . Studies of illness in the aged: The index of ADL. JAMA.
1963. 185. 94. Katz S., Dorons TD, Cash H, R., et al. Progress in the development of the index of
ADL. Gerontologist.10:20-30, 1970.)
The results of the assessment are used to determine the amount of
assistance the patient needs in accordance with his functional abilities: 6
78
points out of 6 indicate that the patient does not need outside care, 4 points
indicate the average severity of functional disorders, in which the question
of outside help is considered, 2 points, as a rule, indicate severe functional
disorders of the patient (table 6).
Patients unable to perform the activities listed in the table usually
need constant supervision, care and support from their carers for
12–24 hours a day.
With the help of tests of the second kind, for example, the Lawton
test IADL scale (table 7, IADL — instrumental activities of daily living
from Lawton et al., 1982), a more extended set of so-called instrumental
indicators is evaluated. They characterize the functional activity of an old
person, which allows him to carry out self-service, that is, to live
separately and independently cope with domestic needs. This includes the
ability to prepare their own meals, make the necessary purchases, take
medicines regularly, manage money, maintain a house, do laundry, use
transport and use the telephone.
The first answer to each of the questions posed (estimated by
3 points) characterizes the ability to independently perform this type of
activity and, therefore, independence from outside help.
Answer 2 (estimated by 2 points) characterizes the ability to perform
this type of activity, subject to partial assistance from outsiders.
Answer 3 (estimated by 1 point) characterizes the loss of this type of
activity and dependence on others.
The score below 27, scored during the patient's survey, is associated
with a decrease in “instrumental” functional activity. Questions 4 through
7 are semi-specific and may be modified by the interviewer.
If patients do not fully maintain the activities indicated in the Katz
and Lawton tables, it is advisable to obtain additional information. This is
information about the social environment (the presence of a family, or a
person capable of providing assistance, relationships with others, the
possibility of social support, etc.), living conditions (a separate house,
apartment or room, the presence of neighbors who are ready to provide
assistance, etc.) and the psychological mood of patients.
79
7. SCALE FOR ASSESSING INSTRUMENTAL
FUNCTIONAL ACTIVITY IN EVERYDAY LIFE
Table 7
(after W.B. Abrams, M.H. Beers, R. Berkowet al., 1995)
Can you use the phone?
Without outside help
With partial help
Completely incapable
3
2
1
Can you get to places that are out of your
normal walking distance?
Without outside help
With partial help
Completely incapable
3
2
1
Can you go grocery shopping?
Without outside help
With partial help
Completely incapable
3
2
1
Can you cook food for yourself?
Without outside help
With partial help
Completely incapable
3
2
1
Can you do housework?
Without outside help
With partial help
Completely incapable
3
2
1
Can you do small “manly” housework?
Without outside help
With partial help
Completely incapable
3
2
1
Can you do laundry for yourself?
Without outside help
With partial help
Completely incapable
3
2
1
Can or would you be able to take your own
medications?
Without outside help
With partial help
Completely incapable
3
2
1
Can you manage your money?
Without outside help
With partial help
Completely incapable
3
2
1
80
One of the important diagnostic indicators of the physical health of
an old person is his gait and ability to maintain balance. You can use a
special scale of the old person's ability to move, maintain balance, change
position (sitting-standing) and gait stability, which is especially important
for predicting falls (table 8).
Table 8
Balance and gait assessment table
(after William B. Arams, Mark H. Beers, Robert Berkowetal., 1995)
Instructions: The patient sits on a hard chair. Checked actions ability
to maintain balance in points _______________ (out of 16 possible).
Position
Action
Points
Sitting balance
Leaning or sliding on the chair
Sits firmly and securely
0
1
Getting up
Incapable without outside help
Able, but with the help of hands
Capable without hands
0
1
2
Trying to get up
Incapable without outside help
Able, but requires more than one attempt
Able to get up on the first try
0
1
2
Maintaining balance
(5 sec.)
Unsteady (staggering, rearranging legs, body
swaying)
Stable but uses a cane, walker, or other item for
support
Stable without a cane, walker or other supporting
device
0
1
2
Standing balance
Unstable
Standing, but with feet wide apart (medial heels
more than 10 cm apart) or using a cane, walker, or
other object for support
Stands with feet together and does not use other
items for support
0
1
2
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