48 American Family Physician
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Volume 83, Number 1 ◆ January 1, 2011
The Geriatric Assessment
BASSEM?ELSAWY,?MD,?and?KIM?E.?HIGGINS,?DO,?Methodist Charlton Medical Center, Dallas, Texas
presenting? with? confusion? may? not? have? a?
neurologic? problem,? but? rather? an? infec-
tion.? Social? and? psychological? factors? may?
and? socioenvironmental? circumstances.? It?
and? over-the-counter? drugs,? vitamins,? and?
The? geriatric? assessment? differs? from? a?
typical? medical? evaluation? by? including?
by? incorporating? a? multidisciplinary? team?
including? a? physician,? nutritionist,? social?
be? less? comprehensive? and? more? problem-
screening? during? each? office? visit.? Patient-
driven? assessment? instruments? are? also?
naires? and? perform? specific? tasks? not? only?
The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person’s
functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually
initiated when the physician identifies a potential problem. Specific elements of physical health that are evaluated
include nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment aids in the
diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of
care; and evaluation of long-term care needs and optimal placement. The geriatric assessment differs from a stan-
dard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life;
and, often, by incorporating a multidisciplinary team. It usually yields a more complete and relevant list of medical
problems, functional problems, and psychosocial issues. Well-validated tools and survey instruments for evaluating
activities of daily living, hearing, fecal and urinary continence, balance, and cognition are an important part of the
geriatric assessment. Because of the demands of a busy clinical practice, most geriatric assessments tend to be less
comprehensive and more problem-directed. When multiple concerns are presented, the use of a “rolling” assess-
ment over several visits should be considered. (Am Fam Physician. 2011;83(1):48-56. Copyright © 2011 American
Academy of Family Physicians.)
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January 1, 2011 ◆ Volume 83, Number 1?
American Family Physician 49
managing? finances,? using? a? telephone).? Physicians? can?
ADL?scale?(Table 1)8?and?the?Lawton?IADL?scale?(Table 2).9?
SORT: KEY RECOMMENDATIONS FOR PRACTICE
The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against
screening with ophthalmoscopy in asymptomatic older patients.
Patients with chronic otitis media or sudden hearing loss, or who fail any hearing screening tests
should be referred to an otolaryngologist.
Hearing aids are the treatment of choice for older patients with hearing impairment, because they
minimize hearing loss and improve daily functioning.
The U.S. Preventive Services Task Force has advised routinely screening women 65 years and older for
osteoporosis with dual-energy x-ray absorptiometry of the femoral neck.
The Centers for Medicare and Medicaid Services encourages the use of the Beers criteria as part of
an older patient’s medication assessment to reduce adverse effects.
C 21, 23
C 39, 40
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented
evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.xml.
Table 1. Katz Index of Independence in Activities of Daily Living
Activities (1 or 0 points) Independence (1 point)* Dependence (0 points)†
Bathes self completely or needs help in bathing only
a single part of the body, such as the back, genital
area, or disabled extremity
Needs help with bathing more than one
part of the body, getting in or out of
the bathtub or shower; requires total
Needs help with dressing self or needs
to be completely dressed
Gets clothes from closets and drawers, and puts
on clothes and outer garments complete with
fasteners; may need help tying shoes
Goes to toilet, gets on and off, arranges clothes,
cleans genital area without help
Needs help transferring to the toilet
and cleaning self, or uses bedpan or
Needs help in moving from bed to chair
or requires a complete transfer
Fecal and urinary continence
Moves in and out of bed or chair unassisted;
mechanical transfer aids are acceptable
Exercises complete self-control over urination and
Is partially or totally incontinent of
bowel or bladder
Gets food from plate into mouth without help;
preparation of food may be done by another person
Needs partial or total help with feeding
or requires parenteral feeding
*—No supervision, direction, or personal assistance.
†—With supervision, direction, personal assistance, or total care.
‡—Score of 6 = high (patient is independent); score of 0 = low (patient is very dependent).
Adapted with permission from Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10(1):23.
56 American Family Physician
Volume 83, Number 1 ◆ January 1, 2011
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