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Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
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131
APPENDIX 1.
MAP OF COMPREHENSIVE GERIATRIC ASSESSMENT OF PATIENT
Passport data and social status
Surname, name,
patronymic of the
patient
Gender: Male
Female
Date of birth (d.m.y.)
(____/____/_______)
Disability
No I II III
Family status
married)
unmarried (not
married)
widower (widow)
divorced
Education
average _____
classes
secondary special
higher
Who lives with
with wife/husband
with kids
one
other:
Profession
Works
Not really
Not working since
____ years
Phone address
Is there someone the patient(s) can turn to for help if
needed?
Yes
Not
Does the patient have a guardian?
Yes
Not
Surname, name,
patronymic, phone
number of the
guardian
Surname, name,
patronymic,
telephone number of
the caregiver
Surname, name,
patronymic, position
of the person who
filled out the card
Date of
completion
132
History and physical status
Concomitant chronic diseases and conditions (with indication of duration)
Arterial
hypertension
Bronchial
asthma
And ischemic heart
disease
Chronic obstructive
pulmonary disease
Postinfarction
cardiosclerosis
Oncological
diseases
Chronic heart failure
Urolithiasis disease
Acute
cerebrovascular
accident in history
peptic ulcer
Diabetes
Trophic ulcers
bedsores
Osteoarthritis
Anemia
Problems with
chewing food
Other diseases
Functions of the pelvic organs
Does involuntary leakage of urine occur
during coughing, laughing, sneezing,
lifting heavy objects?
Never; once a week or less;
2-3 times a week; once a day;
several times a day; all time;
Is there an involuntary leakage of urine
on the way to the toilet?
Never; once a week or less;
2-3 times a week; once a day;
several times a day; all time;
How much urine is leaking?
Small amount (a few drops)
moderate amount
A large number of
Do you have difficulty emptying your
bladder?
Yes
Not
133
How often does the patient get up at
night to urinate?
Do incidents of fecal incontinence
occur?
Never; once a week or less;
2–3 times a week; once a day;
several times a day; all time;
Vision/hearing problems
Diseases of the organ of vision
Cataract
Glaucoma
Increasing macular degeneration
Other
Surgical treatment
Do you have difficulty reading
newspapers/books even with glasses?
Yes
Not
Are faces difficult to recognize even
when wearing glasses?
Yes
Not
Diseases of the organ of hearing
Does the patient have to ask his
interlocutor again? (including when
using a hearing aid)
Not
Rarely
Often
Height (cm)
Shoulder circumference
(cm)
Weight, kg)
Forearm circumference
(cm)
Body Mass Index (kg/m²)
Hip circumference (cm)
Waist circumference (cm)
Calf circumference (cm)
Blood pressure, pulse initially
(sitting)
Blood pressure, pulse after 7 minutes
in a horizontal position
Blood pressure, pulse after moving to
a vertical position
within 1 minute
within
3 minutes
134
Brief Scale Nutritional Assessment (MNA)
1
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
2
Weight loss in the last 3 months
1 = don't know
2 = m body loss from 1 to 3 kg
3 = no weight loss
3
Mobility
0 = chained to bed/chair
1 = able to get out of bed/chair but
does not leave the house
2 = leaves home
4
Acute illness (psychological stress) in
the last 3 months
0 = yes
2 = no
5
Psychoneurological problems
0 = severe memory impairment or
depression
1 = moderate memory impairment
2 = no neuropsychological problems
6
Body mass index
0 = less than 19
1 = 19–21
2 = 21–23
3 = 23 and up
7
Lives independently (not in a nursing
home or hospital)
0 = no
1 = yes
8
Takes more than three medications a
day
0 = yes
1 = no
9
Pressure sores and skin ulcers
0 = yes
1 = no
10
How many times a day does the
patient eat well?
0 = 1 time
1 = 2 times
2 = 3 times
11
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);
135
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)
12
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
13
How much liquid does he drink per
day
0 = less than 3 glasses
0.5 = 3–5 glasses
1 = more than 5 glasses
14
Feeding method
0 = unable to eat without assistance
1 = on my own with little difficulty
2 = self
15
Self-reported nutritional status
0 = rates self as malnourished
1 = rates own nutritional status
indefinitely
2 = rates self as having no nutritional
problems
16
Health status compared to other
people of the same age
0 = not so good
0.5 = don't know
1 = same good
2 = better
17
Circumference in the middle of the
shoulder, cm
0 = less than 21
0.5 = 21–22
1 = 22 and more
18
Calf circumference, cm
0 = less than 31
1 = 31 and more
Total score:
/30
Interpretation of results:
> 23.5 points — normal nutritional status;
17–23.5 points — the risk of malnutrition (malnutrition)/
136
Results of laboratory studies
Hemoglobin, g/l
Cholesterol mmol/l
Creatinine, µmol/l
Low density
lipoproteins,
mmol/l
Glucose, mmol/l
Calcium, mmol/l
Total protein, g/l
Thyrotropic
hormone, kmIU/ml
Albumin g/l
Vitamin B12, pg/ml
Functional status
Dynamometry. Dynamometry is carried out using an electronic or
mechanical dynamometer.
The dynamometer is taken in hand with the dial inward. The hand is
taken away from the body until a right angle is obtained with it. The second
hand is released down along the body. With maximum force, squeeze the
dynamometer for 3–5 seconds. To obtain more accurate results, it is
recommended to measure the grip strength three times on the right and left
hand. Rest time between sets is at least 30 seconds. To evaluate the results,
you can use the average or maximum value of the shaking strength of the
strongest hand.
Criteria for low grip strength by gender and body mass index
Floor
Body mass index, kg/m2
Grip force, kg
Men
< 24
< 29
24:1-26
< 30
26:1-28
< 30
> 28
< 32
Women
< 23
< 17
23:1-26
< 17.3
26:1-29
< 18
> 29
< 21
137
Get up and go test. The patient is sitting on a chair. Then he gets up,
walks 3 meters, turns around, goes to a chair and sits down. During the test,
attention should be paid to signs of impaired gait and balance. Normally
healthy older people usually complete the Get Up and Walk test in
10 seconds or less. The result of the “Get up and walk” test for more than
14 seconds in elderly and senile patients living at home, signs of impaired
gait and balance indicates the presence of a risk of falls
Brief Battery of Physical Functioning Tests
and Interpretation of Results
Definition of equilibrium
Determination of balance in the “Feet together” position. It is necessary to stand for
10 seconds. Less than 10 seconds — 0 points. 10 seconds — 1 point
Determination of balance in a semi-tandem position. It is necessary
to stand for 10 seconds. Less than 10 seconds — 0 points. 10
seconds — 1 point.
Determination of balance in tandem position. It is necessary to stand
for 10 seconds. Less than 3 seconds, 3 — 9.99 seconds — 1 point,
10 seconds — 2 points
Determination of walking speed for 4 meters. First trial try. During the
second and third attempts, the time in seconds for which the patient walks
4 meters is measured. The best score is taken into account. Interpretation:
< 4.82 sec — 4 points; 4.82 — 6.2 sec — 3 points; 6.32 — 8.7 sec —
2 points; > 8.7 sec — 1 point. Can't 0 points
Five-time rise from a chair. Preparation: a single rise from a chair.
Chair without armrests. Crossing your arms over your chest or stomach, you
need to sit down so that the feet are firmly pressed to the floor. Then stand
up with your arms crossed over your chest or stomach. If the patient is
unable to perform a single chair rise without the use of the hands, the 5 chair
138
rise test is not performed. Stop the test in the following cases: if the patient
gets up with the help of his hands, after a minute, if the patient has not been
able to complete the test by this time, at the discretion of the doctor if this is
required to ensure the safety of the patient. Interpretation: ≤ 11.19 sec —
4 points; 11.2 — 13.69 sec — 3 points; 13.7 — 16.69 sec — 2 points;
> 16.7 sec — 1 point; > 60 sec or cannot 0 points
Interpreting the results of the brief battery of physical functioning
tests:
For each stage of the test, points are awarded, points are summed up.
If the patient scores 10–12 points — there is no senile asthenia,
8–9 points — pre-asthenia, 7 points or less — senile asthenia. A score of
1 or less on balance and/or 5 seconds or more on walking speed and/or 1 or
less on a 5 chair rise test indicates a high risk of falls.
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
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
139
Dressing
10 — does not need outside help;
5 — partially needs help, for example, 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
Interpretation of results:
0–20 points — complete dependence;
25–60 points — pronounced dependence;
65–90 points — moderate dependence;
95 — easy dependence;
100 — complete independence
140
Daily Instrumental Activity Scale (IADL)
Telephone
1
Uses the phone on his own initiative, dials numbers
calls
1
Dials several well-known numbers
1 Answers phone calls but does not dial numbers
0 Doesn't use phone at all
Purchases
1
Makes all necessary purchases independently
0 Makes small purchases
0 Accompaniment required for any visit to the store
0 Completely unable to shop
Cooking
1
Plans, prepares and serves the necessary food independently
food
0
Prepares required food if ingredients have been provided
0 Heats and serves food or cooks food but does not follow the required
diet
0 Needs someone to cook and serve food
Doing
1
Maintains the house alone except for occasional help with
homemade
the need for hard work
life
1
Performs simple daily activities such as washing dishes or
making the bed
1 Performs simple daily tasks, but is unable to maintain the required
level of cleanliness in the house
1 Need help with all household chores
0 Not involved in any economic affairs
Wash
1
Washes everything you need
1 Washes small items such as socks, stockings
0 All laundry must be done by someone
Use
1
Independently uses public transport or drives a car
transport
1
Organizes own taxi ride but does not use public
transport
1 Uses public transport if someone helps
or accompanies
0 Travels by taxi or car accompanied by another person
0 Doesn't move
Reception
1
Self-administers necessary medications in the correct
medicines
0
dosages and at the right time
Takes medicine if it was prepared by someone to take it in the
required dose
0 Unable to self-medicate
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