GLOBAL GERIATRIC EVALUATION

It’s a diagnosis process that detects de problems, needs and the capacity of the old age, such us mental, functional, clinical and social aspects.

OBJECTIVES

  -  Progress the diagnosis.

  -  Found problems that before we didn’t found.

  -  Progress the functional and cognitive state.

  -  Progress life quality.

  -  Know the family surrounding.

  -  Reduce the mortality.

Physical clinical evaluation

  1. Interview.

  2. Questions about de geriatric symptoms.

  3. Pharmacological story.

  4. Nutritional story.

  5. Physical exploration.

  6. Exploration complement.

  7. Do a list with problems and care nursing.

Geriatrics symptoms

  -  Immobility.

  -  Skin integrity.

  -  Altered intelligence.

  -  Instability.

  -  Incontinence.

  -  Immunodeficiency.

  -  Sensorial insufficiency.

  -  Poverty.

  -  Fateful.

ANAMNESIS

The nurse must be attentive to the next limitations:

1. Communication: do short interviews, speak to their high, give their time to answer us, talk with the family or principal career to get more information.
2. Symptoms description: the signs and symptoms are diffused, so we must ask their easy questions. With these questions we are going to do the Henderson's valuation.
3. Numerous grumbles: they mix the symptoms so we listen all of theme, we ask many times, and classified the pathologies according to the priority and gravity.

The next sections must be included in the anamnesis:

• Personal history: diagnosis, hospital admits, surgeries, nursing actuations in the past. 
• Henderson’s valuation: cardiovascular, respiratory, nervous, tegumentary, digestive, endocrine and genitourinary system.
• Pharmacological history: treatment and dose in the last year and in the moment of the evaluation. With this we want detect symptoms of the secondary effects of the medicines.
• Nutritional history: diet, number of lunches per day, prescript diet. In this case we can use the Mini Nutritional Assessment (MNA). If the patient has more than 17 points in this test, there is a malnutrition risk.

Sometimes, do the anamneses is so difficult because the patients have some incapacities, like deafness, expression difficulty, physic problems…

For that, we have to take the time they need to complete de anamneses. If it’s necessary, talk to them with signals, opening the mouth to a better understanding and looking directly face to face.

I think we don’t waste time on this interview because in medical center the nurse and the doctor have much patients and not much time. 

But in my view, we should expend more time in this because we can extract much information that is as important as we extract with de physical exploration. 

PHYSICAL EXPLORATION

The first we do is: evaluate the physic aspect, personal care, cleanliness and hygiene. After that, we take his the vital sign.

• Blood pressure, weight, height, temperature.
• Skin: look for skin injury, ulcers or carcinomas.
• Head and neck: palpate arteries, visual acumen, cataracts, visual hearing and palpate the thyroid.
• Thorax: breathing pattern, capacity to cough, cardiac auscultation, analyze women’s breasts.
• Abdomen: look for masses, hernias, rectal touch and gynecologic exploration.
• Nervous system: motor role, balance, march, sensitivity, motor coordination and trembling.
• Vascular periphery system: pulse and varicose veins.
• Musculoskeletal exploration: deformities, mobility’s limitations, crunches, atrophies and swelling.

LABORATORY

  -  Complete hemogram.

  -  Biochemistry.

  -  Blood in faeces.

  -  ECG.

  -  Mantoux and X – ray.

  -  Mammogram.

With this valuation we collect information about de capacity of the elderly person to do their common activities, like have a shower, eat, cook, get dressed…

To do this evaluation we use scales. The most important are: Lawton and Brody scale, Katz scale and Barthel scale.

It’s important know that when the functional rank reduces there are many things that increases:

  -  Mortality risk.

  -  Hospital admits.

  -  Medical visits.

  -  Drugs consumption.

  -  Necessity of social ways.

MENTAL AND SOCIAL VALUATION

• 25% elderly person suffers some psychic diseases.
• Anxiety and depression are the most common diseases in this age.
• Biologic factors: family precedent, changes in the neurotransmission associated to the age, sex and race.
• Medical factors: diseases, chronic diseases associated to de pain and terminal diseases.
• Functional factors: if they interact with the depression, the prognostic will be negative.
• Psychic factors: alcoholism, anxiety and dementia.
• Social factors: widowhood, hospitalization, loneliness, death of a close person.

In some occasions, depression, anxiety… is hidden by other physical diseases and is such as important like the other and we have to treated it too.

Clinical interview

We star the interview when the patient enters in the office. We’ll talk with the family too.

• Interrogate about family history, profession, drugs, the reason why the he comes, problems in recognize of friends and the family.
• Language.
• Deliriums, excitements, hallucinations and roam.

Here, there are the most common scales: 

  •  Pfeiffer questionnaire. 

  •  Mini – mental State Examination of Folstein (MMSE). 

  •  MEC.

  •  Clock Test.

SOCIAL EVALUATION

The most common scale is: ORS scale. This scale provides information about: family structure and social resources, economic resources, mental health, physic health and capacity to do AVD.

EMOTIONAL CAPACITY VALUATION

The nurse must ask about:

  -  Emotional state.

  -  Appetite upset.

  -  Dream upset.

  -  Signs of anxiety.

  -  Concept of death.

The scales we use are:

  -  Yesavage depression scale. 

  -  Hamilton depression scale. 

  -  Goldberg depression and anxiety scale.