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Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
.pdf
141
Financial
1
Independently controls financial issues (budget, verification
operations
1
checks, rent, bank visits), controls income Does daily shopping, but
needs help with banking and large purchases
0 Unable to manage money independently
Total score: /8
For each category of activity, a level is selected corresponding to the activities
performed by the patient, and a score is awarded — 0 or 1.
The overall result can vary from 0 points (dependent on outside help, needs
significant help when performing instrumental functional activity) to 8 points
(independent of outside help). 3 points — without outside help; 2 points — with partial
help
Morse scale for assessing the risk
of falls in hospitalized elderly and senile patients
Question
Ball
1. Have you fallen in the last 3 months?
No — 0
Yes — 25
2. Is there a concomitant disease? See medical card
No — 0
Yes — 15
3. Independence when walking:
J Walks alone (even if assisted), or strict bed rest, immobile
• S Crutches/walkers/canes
• S Supports walking on furniture or walls
0
15
30
4. Intravenous infusion given/set
intravenous catheter
No — 0
Yes — 20
5. Gait
J Normal (walks freely)
• S Slightly tight (walks with stops, steps are short,
sometimes delayed)
• S Violated (cannot stand up, walks leaning, looks down)
0
10
20
6. Mental state
J knows his ability to move
• S does not know or forgets that assistance is needed when
driving.
0
15
142
Key (interpretation):
0–24 points — no risk of falls;
25–50 — low risk of falls;
51 points or more — high risk of falls
Psychological status
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:
/fifteen
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
Interpretation of results:
0–4 points — no depression;
5 or more points — probable depression
143
Mini Cog Test
Ask the patient to repeat after you and remember three words: Lemon,
Key, Ball
Ask the patient to draw a round clock face, arrange all the numbers
and place all the hands so that the clock shows 11 hours 10 minutes.
Ask the patient to reproduce the words after completing the clock
drawing test.
Interpretation:
Memorization of words. The patient receives one point for each word
repeated without a prompt (total 0–3 points).
Clock drawing: the test result can be from 0 to 2 points: 1 point — all
the numbers are arranged in the correct order and approximately in the place
they occupy on the dial, 1 point — the arrows indicate the correct time; the
length of the hands (hour, minute) is not evaluated. Inability or refusal to
draw a clock — 0 points).
The overall result is the sum of the results of the two tasks
“Memorizing words” and “Drawing a clock” and ranges from 0 to 5 points.
If less than 3 points are scored, this is the basis for suggesting dementia. A
result of less than 4 points indicates the need for a deeper examination of
cognitive functions.
Explanations: the implementation of this technique allows you to
quickly assess the presence of undoubted cognitive impairment. May not be
sufficiently sensitive to non-demented cognitive disorders.
In addition, if the patient reproduced all the words, there is no
dementia. If the patient cannot reproduce the words, there is reason to
suspect dementia. If the patient reproduced the words partially, you should
refer to the result of the test with a clock. If the drawing of the clock is
disturbed, the doctor makes a provisional diagnosis of dementia. If the
arrows are drawn correctly, there is no dementia.
It is important to pay attention to the condition of the patient's
vision — if the vision is poor, the result may be false positive.
144
Examples of watches drawn by patients
Mental Status Assessment (MMSE)
for changes in the mini-Cog test
Parameter
Answers in points
1. Orientation in time: ask the patient to indicate
5
Number
one
Month
one
Year
one
Day of the week
one
2. Orientation in place: ask the patient to tell where he is
5
Country
one
Region
one
City
one
Clinic
one
Floor
one
3. Immediate reproduction: name three unrelated objects and
ask the patient to repeat
3
Pencil
one
House
one
penny
one
145
Parameter
Answers in points
4. Attention concentration and counting: ask the patient to
subtract 7 from 100 5 times in succession (or say the word
“the earth is reversed”)
5
100 – 7 = 93
one
93 – 7 = 86
one
86 – 7 = 79
one
79 – 7 = 72
one
72 – 7 = 65
one
5. Delayed recall: ask the patient to recall the 3 items named
during the immediate recall test
3
Pencil
one
House
one
penny
one
6. Speech and action: Show a pen and watch and ask what
it's called
2
Watch
one
A pen
one
Please repeat the sentence: “No ifs, and or buts”
one
Ask the combatant to perform a sequence of 3 actions: “Take
a piece of paper with your right hand, fold it in half and put
it on the floor”
3
Write on a piece of paper “Close your eyes”, show the
patient and ask him to do what he read
one
Ask the patient to write a sentence (the sentence must have a
subject and a predicate, it must make sense)
one
Ask the patient to copy the drawing
one
Total score
The total score on the scale is a maximum of 30 points.
28–30 points — this is the norm;
27–25 points — non-dementia cognitive disorders;
24 points or less — dementia (approximately 20–24 points — mild dementia;
11–19 points — moderate dementia; 0–10 points — severe dementia).
146
Diagnosis of delirium CAMP — test
1
Sharpness and undulation of changes in mental status
Are there changes in mental status from baseline? OR
Has there been a fluctuating change in mental status in the
past 24 hours?
If the answer to
both questions
is “no”, then
DELIRIUM is
NO
If the answer to
one of the
questions is
“yes”, then 4.2
2
Attention disorder:
Squeeze my hand every time I say the letter A
Read the following sequence of letters
“L A M P A A L A D I N A”
ERRORS: does not compress on the letter A and compresses
on other letters
If 0–2 errors,
then there is NO
DELIRIA
If more than
2 errors, then
4.3
3
Changes in the level of consciousness
The level of consciousness at the current moment (according
to RASS) See Appendix No. 1
If RASS is
different from 0,
then DELIRIUS
EXISTS If
RASS = 0, then
3.4
4
Disorganized thinking:
Will the stone float on water?
Do fish live in the sea?
Does one kilogram weigh more than two?
Can a hammer hammer a nail?
Command: “show how many fingers” (show 2 fingers)
“Now do the same with the other hand” (do not demonstrate)
OR “Add another finger” (if the patient cannot move both
hands)
If more than
2 errors, then
DELIRIUM IS
If 0–1 error then
no delirium
CONCLUSION: DELIRIUM/no delirium
147
The Richmond Agitation-Sedation Scale (RASS)
+4 Warlike: belligerent, aggressive, dangerous to others
+3 Very agitated: aggressive, tries to rip out tubes, IV or catheter
+2 Excited: frequent, aimless movements, resistance to procedures
+1 Restless: anxious, non-aggressive movements
0 Calm and attentive
–1 Drowsy: inattentive, drowsy, but always reacts to the voice,
–2 Light sedation: wakes up for a short time to the voice,
–3 Medium sedation: movements or eye opening to voice but no eye
contact
Assessing the need for social services
Social Service Needs Rating Scale
Part 1. Functional status
Mobility check. Falls
1. Independent when walking with the use of improvised means and/or
without
0
2. Self using wheelchair/needs help getting out of bed/needs help getting
upstairs
0.5
3. Needs constant help getting out of chair or bed/needs help moving from
wheelchair to bed, but is independent when using wheelchair for mobility
1
4. Needs constant help with moving and getting up from a sitting position to a
standing position; falls > once a month
1.5
5. Needs constant help with walking; falls > once a week
2
6. Completely dependent on movement; confined to a wheelchair, recumbent
7
Dressing
7. Gets dressed unaided
0
8. Needs Moderate Help Getting Dressed
0.5
9. Needs a lot of help getting dressed.
1
Personal hygiene
10. Washes without assistance
0
11. Requires the presence of another person when bathing
0.5
12. Needs moderate help bathing
1
13. Needs maximum help when bathing, it is necessary to wash completely
1.5
148
Food and drink
14. Self-heats and eats food and does not need help with medication
0
15. Needs help warming/serving food to the table, but eats on his own and/or
needs supervision and help preparing portions of medication
1.0
16. Unable to eat or drink on their own and/or need full medication control
1.5
Toilet use
17. Independently uses the toilet, carries out hygiene. Controls defecation and
urination
0
18. Uses the toilet on his own, but needs to be accompanied and supervised.
1.0
19. Uses the toilet but needs to be accompanied, assisted with hygiene and/or
dressing.
2
20. Completely dependent on outside help to use the toilet. Does not control
any of the shipments
7
TOTAL
Part 2. Cognitive status
Yes
Not
He speaks and behaves adequately, is sociable, not aggressive, is not in
a depressed and depressed mood
0
3
Oriented in time (day and night, morning and evening) and familiar
space, the ability to generalize is preserved
0
3
TOTAL
Criteria and description of levels of need for social services
The final score
for parts 1 and 2
of the scale and
the level of need
for social services
Group Description
0.5–1.5 points
Group A
Brings together people who need limited assistance with
personal hygiene, food preparation and cleaning.
Most often, people from this category have partially lost the
ability to self-service, they need little help to meet certain
vital needs, assistance in cleaning hard-to-reach places,
assistance in hanging clean linen.
149
The final score
for parts 1 and 2
of the scale and
the level of need
for social services
Group Description
Cognitive functions in this category of people are not
impaired.
The health of these people is in a stable state, controlled by
drug therapy. Most likely, they do not require frequent
hospitalizations, but require dispensary observation.
The level corresponds topre-frail older adults, maybe
single geriatric syndromes (such as sensory deficits that do
not lead to drastic restrictions on their functional status).
2–4 points
Group B
The ability to self-care is reduced. People from this group,
who need help in moving around the house, use technical
means of rehabilitation. Need help with dressing and
personal hygiene — need partial help with bathing;
It is possible to perform only partial cleaning within the
reach of a person’s hand, help is needed to maintain living
conditions. Assistance with food preparation is often needed.
Cognitive functions in this category of people are not
impaired.
4.5–7.0
Group C
It unites people who have partially lost the ability to selfservice, due to a health disorder with a persistent pronounced
disorder of body functions due to diseases, the consequences
of injuries or defects, leading to a pronounced limitation of
one of the categories of life activity or a combination of
them, but most often retained mental independence.
People in this group who need help daily and repeatedly to
perform activities of daily life (assistance with mobility,
accompaniment outside the home, assistance with getting up,
significant help with bathing and dressing).
Significant assistance is needed in cleaning, washing,
cooking hot meals. Need supervision/assistance with
medication
7.5–9 points
Group D
People of this group are not capable of self-service and
performing instrumental everyday activities without outside
help, often chained to a bed or chair, while their mental
150
The final score
for parts 1 and 2
of the scale and
the level of need
for social services
Group Description
functions are not completely impaired, they need help in
various activities in everyday life.
This group may include persons whose mental functions are
severely impaired, while they retained the ability to move.
In both cases, the degree of a person's dependence on outside
help leads to a pronounced limitation of one of the categories
of life activity or a combination of them.
The degree of functionality corresponds to 1–2 disability
groups. Significant assistance needed with self-care with
assistive devices and/or assistance from others:
dressing/bathing/eating/water intake/management of
medications/assistance with personal care products/moving
around the house/handling and caring for compensatory
medical supplies devices
The ability to orientate in time and space is often impaired,
requiring the help of others;
It is necessary to maintain the ability to communicate and the
ability to control one's behavior.
9.5 points or more
Group E
People from this group are chained to a bed or an armchair,
their mental functions are severely impaired, and they need
the constant presence of helpers. People from this group may
be mentally healthy, but need palliative care and constant
care.
The degree of functionality corresponds to disability group 1
with a persistent, significantly pronounced disorder of body
functions
After the CGO, the doctor makes a conclusion and formulates
recommendations
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