Frailty Syndrome

Comprehensive Geriatric Exam

100

What social aspects should a physician evaluate during a geriatric exam? (name two) 

- social 

- economic 

- environmental 

- spiritual 

- preferences regarding advanced directives 

200

How should a physician treat a new geriatric patient coming for a physical exam compared to an established patient? 

- best to do comprehensive geriatric assessment 

- depend on patient or patient's companion to provide a record of what has changed and when 

300

What are physical exams should be done during a comprehensive geriatric exam? (name three) 

- gait and balance 

- lying and standing BP 

- functional ability (hygiene, choice of attire) 

- cognition and mood

- assessment of non-concordant patient 

- sensory loss 

- posture 

- pain/joints 

- weight and nutrition 

400

Explain the risk factors associated with the gait found in the patient. (heel to toe) 

- high falling risk 

- reduced mobility 

- diminished quality of life 

- serious injuries including major fractures and head trauma 

500

Name 3 components of gait analysis 

• Observe gait with patient walking toward you
• Observe patient walking away from you
• Observe patient walking side to side
• Observe length of stride, swing of arm, heel strike, toe off, titling of the pelvis and adaptation of the shoulders
• One looks for the functional capacity of the gait, not the usual pathological conditions. Of particular importance is the cross-patterning of the gait and symmetry of stride

Lifestyle and Frailty management options

100

Explain PHQ-2 and PHQ-9 

• PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past two weeks (positive or negative)
• PHQ-9 screening, diagnosing, monitoring and measuring the severity of depression (scale)

200

Describe lifestyle changes in relation to treatment options. 

- senior center for social activities 

- seek out transportation for other activities such as church 

- this is related to her mild depression monitor for improvement of symptoms

300

Describe the need for multidisciplinary team

- aging and frailty affects all organ systems 

- dietitian is required to monitor nutrition and weight gain 

- PT is needed to recover some proprioception and coordination 

- NP is to ensure that medication and other regiments are followed accordingly 

400

Rationalize the use of follow up assessments 

- help patients see their progress

- ensure that there is no need to upgrade to more intense intervention 

500

Contrast home-based intervention with alternative interventions 

- home based interventions allow for maintenance of independence

- upgrade to next level of care is based on the distinction of frailty v disability 

- full time care would indicate nursing home 

- other alternates would be skilled nurse facilities, rehab facilities and assisted living