American Academy of Family Physicians Assessing Elderly Cancer Patients
The Geriatric Assessment
A more recent article on geriatric cess is available.
Am Fam Doc. 2011 Jan 1;83(1):48-56.
Article Sections
- Abstract
- Functional Ability
- Physical Health
- Cognition and Mental Wellness
- Socioenvironmental Circumstances
- Trouble List
- References
The geriatric cess is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional power, physical wellness, cognition and mental health, and socioenvironmental circumstances. It is ordinarily initiated when the physician identifies a potential trouble. 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 weather condition; development of treatment and follow-upward plans; coordination of management of care; and evaluation of long-term care needs and optimal placement. The geriatric cess differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, oftentimes, by incorporating a multidisciplinary team. Information technology usually yields a more complete and relevant list of medical problems, functional problems, and psychosocial problems. 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" assessment over several visits should be considered.
Approximately one-one-half of the ambulatory principal intendance for adults older than 65 years is provided by family physicians,1 and approximately 22 percent of visits to family physicians are from older adults.ii,3 It is estimated that older adults will comprise at least 30 per centum of patients in typical family medicine outpatient practices, lx percent in infirmary practices, and 95 per centum in nursing dwelling and home care practices.4
A complete assessment is ordinarily initiated when the physician detects a potential problem such as confusion, falls, immobility, or incontinence. However, older persons frequently practice not nowadays in a typical style, and atypical responses to illness are mutual. A patient presenting with confusion may not have a neurologic problem, only rather an infection. Social and psychological factors may also mask classic disease presentations. For case, although thirty percent of adults older than 85 years have dementia, many physicians miss the diagnosis.5,vi Thus, a more than structured arroyo to assessment can be helpful.
The geriatric assessment is a multidimensional, multidisciplinary cess designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It includes an all-encompassing review of prescription and over-the-counter drugs, vitamins, and herbal products, as well every bit a review of immunization status. This cess aids in the diagnosis of medical conditions; development of handling and follow-upwardly plans; coordination of management of care; and evaluation of long-term care needs and optimal placement.
The geriatric cess differs from a typical medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, past incorporating a multidisciplinary squad including a physician, nutritionist, social worker, and physical and occupational therapists. This type of assessment often yields a more than complete and relevant list of medical problems, functional problems, and psychosocial problems.vii
Because of the demands of a busy clinical do, most geriatric assessments tend to exist less comprehensive and more problem-directed. For older patients with many concerns, the utilise of a "rolling" assessment over several visits should be considered. The rolling cess targets at to the lowest degree 1 domain for screening during each office visit. Patient-driven assessment instruments are besides popular. Having patients consummate questionnaires and perform specific tasks not merely saves fourth dimension, just also provides useful insight into their motivation and cognitive power.
SORT: KEY RECOMMENDATIONS FOR Practice
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| The U.Southward. Preventive Services Task Force found insufficient bear witness to recommend for or against screening with ophthalmoscopy in asymptomatic older patients. | C | 15 |
| Patients with chronic otitis media or sudden hearing loss, or who neglect any hearing screening tests should be referred to an otolaryngologist. | C | 21, 23 |
| Hearing aids are the treatment of choice for older patients with hearing damage, because they minimize hearing loss and better daily functioning. | A | 23 |
| The U.S. Preventive Services Task Forcefulness has advised routinely screening women 65 years and older for osteoporosis with dual-energy ten-ray absorptiometry of the femoral neck. | A | 37 |
| The Centers for Medicare and Medicaid Services encourages the use of the Beers criteria as part of an older patient'due south medication assessment to reduce adverse effects. | C | 39, 40 |
Functional Ability
- Abstract
- Functional Ability
- Physical Health
- Noesis and Mental Wellness
- Socioenvironmental Circumstances
- Problem List
- References
Functional status refers to a person's ability to perform tasks that are required for living. The geriatric assessment begins with a review of the ii key divisions of functional ability: activities of daily living (ADL) and instrumental activities of daily living (IADL). ADL are self-care activities that a person performs daily (e.yard., eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling float and bowel functions). IADL are activities that are needed to live independently (e.g., doing housework, preparing meals, taking medications properly, managing finances, using a telephone). Physicians tin acquire useful functional information by only observing older patients every bit they complete simple tasks, such as unbuttoning and buttoning a shirt, picking up a pen and writing a sentence, taking off and putting on shoes, and climbing upward and down from an examination table. Two instruments for assessing ADL and IADL include the Katz ADL scale (Tabular array 1)8 and the Lawton IADL scale (Table 2).nine Deficits in ADL and IADL can indicate the need for more in-depth evaluation of the patient'southward socioenvironmental circumstances and the need for additional assistance.
Table ane
Katz Alphabetize of Independence in Activities of Daily Living
| Activities (i or 0 points) | Independence (one betoken)* | Dependence (0 points) † | |
|---|---|---|---|
| Bathing | Bathes self completely or needs assistance in bathing only a single part of the body, such as the back, genital area, or disabled extremity | Needs help with bathing more than ane office of the trunk, getting in or out of the bathtub or shower; requires total bathing | |
| Points:______ | |||
| Dressing | Gets clothes from closets and drawers, and puts on dress and outer garments complete with fasteners; may need help tying shoes | Needs help with dressing cocky or needs to be completely dressed | |
| Points:______ | |||
| Toileting | Goes to toilet, gets on and off, arranges wearing apparel, cleans genital surface area without help | Needs help transferring to the toilet and cleaning self, or uses bedpan or commode | |
| Points:______ | |||
| Transferring | Moves in and out of bed or chair unassisted; mechanical transfer aids are acceptable | Needs aid in moving from bed to chair or requires a complete transfer | |
| Points:______ | |||
| Fecal and urinary continence | Exercises complete self-control over urination and defecation | Is partially or totally incontinent of bowel or float | |
| Points:______ | |||
| Feeding | Gets food from plate into oral fissure without assistance; preparation of food may be done past some other person | Needs partial or full help with feeding or requires parenteral feeding | |
| Points:______ | |||
| Total points‡: _________ | |||
Table two
Lawton Instrumental Activities of Daily Living Scale (Self-Rated Version)
| For each question, circle the points for the answer that best applies to your situation. | |||
| 1. Can you use the telephone? | |||
| Without help | iii | ||
| With some help | two | ||
| Completely unable to employ the telephone | 1 | ||
| 2. Can you get to places that are out of walking altitude? | |||
| Without help | 3 | ||
| With some help | 2 | ||
| Completely unable to travel unless special arrangements are made | i | ||
| three. Can you go shopping for groceries? | |||
| Without help | 3 | ||
| With some help | ii | ||
| Completely unable to do whatsoever shopping | 1 | ||
| 4. Tin can you prepare your own meals? | |||
| Without help | three | ||
| With some help | 2 | ||
| Completely unable to prepare any meals | 1 | ||
| 5. Can you do your own housework? | |||
| Without help | three | ||
| With some help | 2 | ||
| Completely unable to do whatever housework | 1 | ||
| six. Can you do your own handyman work? | |||
| Without help | iii | ||
| With some help | 2 | ||
| Completely unable to do any handyman work | 1 | ||
| 7. Tin can you do your ain laundry? | |||
| Without help | 3 | ||
| With some assistance | 2 | ||
| Completely unable to practice any laundry | 1 | ||
| 8a. Do you use whatever medications? | |||
| Yes (If "yes," reply question 8b) | 1 | ||
| No (If "no," answer question 8c) | 2 | ||
| 8b. Practise y'all take your ain medication? | |||
| Without aid (in the right doses at the right time) | 3 | ||
| With some help (have medication if someone prepares it for you or reminds you to take it) | 2 | ||
| Completely unable to take own medication | 1 | ||
| 8c. If you had to accept medication, could y'all do it? | |||
| Without help (in the right doses at the correct time) | three | ||
| With some assist (take medication if someone prepares it for yous or reminds yous to take it) | ii | ||
| Completely unable to have ain medication | 1 | ||
| ix. Can you lot manage your ain coin? | |||
| Without aid | iii | ||
| With some help | ii | ||
| Completely unable to handle money | ane | ||
Physical Health
- Abstract
- Functional Ability
- Physical Health
- Knowledge and Mental Health
- Socioenvironmental Circumstances
- Problem Listing
- References
The geriatric cess incorporates all facets of a conventional medical history, including main trouble, current affliction, past and current medical issues, family and social history, demographic data, and a review of systems. The approach to the history and physical examination, all the same, should exist specific to older persons. In particular, topics such as nutrition, vision, hearing, fecal and urinary continence, balance and autumn prevention, osteoporosis, and polypharmacy should be included in the evaluation. Table 3 is an example of a focused geriatric physical examination.
Table iii
Sample Focused Geriatric Physical Examination
| Signs | Physical sign or symptom | Differential diagnoses | |
|---|---|---|---|
| Vital signs | |||
| Blood force per unit area | Hypertension | Adverse effects from medication, autonomic dysfunction | |
| Orthostatic hypotension | Adverse effects from medication, atherosclerosis, coronary artery disease | ||
| Center rate | Bradycardia | Adverse furnishings from medication, heart cake | |
| Irregularly irregular centre rate | Atrial fibrillation | ||
| Respiratory rate | Increased respiratory rate greater than 24 breaths per minute | Chronic obstructive pulmonary disease, congestive heart failure, pneumonia | |
| Temperature | Hyperthermia, hypothermia | Hyper- and hypothyroidism, infection | |
| General | Unintentional weight loss | Cancer, low | |
| Weight gain | Adverse effects from congestive centre failure medication | ||
| Caput | Disproportionate facial or extraocular muscle weakness or paralysis | Bell palsy, stroke, transient ischemic attack | |
| Frontal bossing | Paget disease | ||
| Temporal avenue tenderness | Temporal arteritis | ||
| Eyes | Eye pain | Glaucoma, temporal arteritis | |
| Impaired visual vigil | Presbyopia | ||
| Loss of primal vision | Age-related macular degeneration | ||
| Loss of peripheral vision | Glaucoma, stroke | ||
| Ocular lens opacification | Cataracts | ||
| Ears | Hearing loss | Acoustic neuroma, adverse effects from medication, cerumen impaction, faulty or sick-plumbing equipment hearing aids, Paget illness | |
| Mouth, pharynx | Gum or rima oris sores | Dental or periodontal affliction, ill-fitting dentures | |
| Leukoplakia | Cancerous and precancerous lesions | ||
| Xerostomia | Age-related, Sjögren syndrome | ||
| Cervix | Carotid bruits | Aortic stenosis, cerebrovascular disease | |
| Thyroid enlargement and nodularity | Hyper- and hypothyroidism | ||
| Cardiac | Fourth heart sound (S4) | Left ventricular thickening | |
| Systolic ejection, regurgitant murmurs | Valvular arteriosclerosis | ||
| Pulmonary | Barrel chest | Emphysema | |
| Shortness of breath | Asthma, cardiomyopathy, chronic obstructive pulmonary disease, congestive middle failure | ||
| Breasts | Masses | Cancer, fibroadenoma | |
| Abdomen | Pulsatile mass | Aortic aneurysm | |
| Gastrointestinal, genital/rectal | Atrophy of the vaginal mucosa | Estrogen deficiency | |
| Constipation | Adverse effects from medication, colorectal cancer, dehydration, hypothyroidism, inactivity, inadequate cobweb intake | ||
| Fecal incontinence | Fecal impaction, rectal cancer, rectal prolapse | ||
| Prostate enlargement | Benign prostatic hypertrophy | ||
| Prostate nodules | Prostate cancer | ||
| Rectal mass, occult claret | Colorectal cancer | ||
| Urinary incontinence | Bladder or uterine prolapse, detrusor instability, estrogen deficiency | ||
| Extremities | Abnormalities of the feet | Bunions, onychomycosis | |
| Diminished or absent lower extremity pulses | Peripheral vascular disease, venous insufficiency | ||
| Heberden nodes | Osteoarthritis | ||
| Pedal edema | Adverse effects from medication, congestive heart failure | ||
| Muscular/skeletal | Diminished range of motion, pain | Arthritis, fracture | |
| Dorsal kyphosis, vertebral tenderness, back pain | Cancer, compression fracture, osteoporosis | ||
| Gait disturbances | Adverse effects from medication, arthritis, deconditioning, pes abnormalities, Parkinson disease, stroke | ||
| Leg hurting | Intermittent claudication, neuropathy, osteoarthritis, radiculopathy, venous insufficiency | ||
| Muscle wasting | Cloudburst, malnutrition | ||
| Proximal muscle pain and weakness | Polymyalgia rheumatica | ||
| Pare | Erythema, ulceration over pressure points, unexplained bruises | Anticoagulant employ, elderberry abuse, idiopathic thrombocytopenic purpura | |
| Premalignant or malignant lesions | Actinic keratoses, basal cell carcinoma, malignant melanoma, force per unit area ulcer, squamous jail cell carcinoma | ||
| Neurologic | Tremor with rigidity | Parkinson disease | |
SCREENING FOR DISEASE
In the normal crumbling process, there is often a decline in physiologic role that is ordinarily not disease-related. Still, treatment of diabetes mellitus, hypertension, and glaucoma can forbid significant future morbidity. Screening for malignancies may allow for early on detection, and some are curable if treated early. It is important that physicians weigh the potential harms of screening before screening older patients. It is essential to consider family preferences regarding handling if a illness is detected, and the patient's functional status, comorbid atmospheric condition, and predicted life expectancy. If an asymptomatic patient has an expected survival of more than 5 years, screening is generally medically warranted, assuming that the patient is at gamble of the disease and would accept treatment if early disease was detected.10,11
The Agency for Healthcare Enquiry and Quality has developed an online tool chosen the Electronic Preventive Services Selector (http://epss.ahrq.gov/ePSS/search.jsp) that tin can be downloaded to smartphones. It can assist physicians in identifying age-appropriate screening measures.
NUTRITION
A nutritional cess is important because inadequate micronutrient intake is common in older persons. Several historic period-related medical weather condition may predispose patients to vitamin and mineral deficiencies. Studies have shown that vitamins A, C, D, and B12; calcium; iron; zinc; and other trace minerals are often deficient in the older population, even in the absence of conditions such as pernicious anemia or malabsorption.12 There are four components specific to the geriatric nutritional assessment: (1) nutritional history performed with a nutritional health checklist; (2) a record of a patient's usual food intake based on 24-60 minutes dietary retrieve; (three) concrete examination with particular attending to signs associated with inadequate nutrition or overconsumption; and (4) select laboratory tests, if applicative. 1 simple screening tool for nutrition in older persons is the Nutritional Health Checklist (Table 4).13
Table 4
Nutritional Health Checklist
| Statement | Yes |
|---|---|
| I have an illness or condition that made me change the kind or amount of food I consume. | 2 |
| I consume fewer than two meals per twenty-four hours. | 3 |
| I eat few fruits, vegetables, or milk products. | two |
| I accept 3 or more than drinks of beer, liquor, or vino almost every day. | 2 |
| I take molar or mouth bug that make it hard for me to eat. | 2 |
| I don't always accept plenty money to buy the food I need. | iv |
| I consume lonely most of the time. | 1 |
| I accept iii or more different prescription or over-the-counter drugs per twenty-four hours. | ane |
| Without wanting to, I take lost or gained 10 lb in the past six months. | 2 |
| I am not always physically able to shop, cook, or feed myself. | two |
VISION
The near common causes of vision damage in older persons include presbyopia, glaucoma, diabetic retinopathy, cataracts, and age-related macular degeneration.14 The U.S. Preventive Services Task Force (USPSTF) found insufficient testify to recommend for or confronting screening with ophthalmoscopy in asymptomatic older patients.15 In 1995, the Canadian Task Force on the Periodic Health Examination advised primary intendance physicians to use a Snellen chart to screen for visual acuity, and recommended that older patients who have had diabetes for at to the lowest degree five years have an assessment by an ophthalmologist. Additionally, the chore strength advised that patients at high adventure of glaucoma, including blackness persons and those with a positive family history, diabetes, or astringent myopia, undergo periodic assessment by an ophthalmologist.16
HEARING
Presbycusis is the third most common chronic condition in older Americans, afterwards hypertension and arthritis.17 The USPSTF is updating its 1996 recommendations, just currently recommends screening older patients for hearing impairment by periodically questioning them about their hearing.18 Audioscope exam, otoscopic examination, and the whispered vocalism examination are also recommended. The whispered voice test is performed past standing approximately 3 ft behind the patient and whispering a serial of letters and numbers after exhaling to assure a quiet whisper. Failure to repeat most of the letters and numbers indicates hearing impairment.19 As function of the Medicare-funded initial preventive physical examination, physicians are encouraged to use hearing screening questionnaires to evaluate an older patient's functional ability and level of safety.20 Questionnaires such equally the screening version of the Hearing Handicap Inventory for the Elderly accurately identify persons with hearing impairment21 (Table 5 22). Additionally, patients' medications should be examined for potentially ototoxic drugs. Patients with chronic otitis media or sudden hearing loss, or who fail any screening tests should be referred to an otolaryngologist.21,23 Hearing aids are the treatment of choice for older persons with hearing impairment, because they minimize hearing loss and amend daily functioning.23
Table 5
Screening Version of the Hearing Handicap Inventory for the Elderly
| Question | Yes (four points) | Sometimes (2 points) | No (0 points) |
|---|---|---|---|
| Does a hearing problem cause you to feel embarrassed when you meet new people? | _____ | _____ | ______ |
| Does a hearing problem crusade yous to experience frustrated when talking to members of your family? | ______ | ______ | ______ |
| Practice you lot take difficulty hearing when someone speaks in a whisper? | ______ | ______ | ______ |
| Do you experience impaired by a hearing problem? | ______ | ______ | ______ |
| Does a hearing problem cause y'all difficulty when visiting friends, relatives, or neighbors? | ______ | ______ | ______ |
| Does a hearing problem crusade y'all to attend religious services less often than you would like? | ______ | ______ | ______ |
| Does a hearing problem crusade you to have arguments with family unit members? | ______ | ______ | ______ |
| Does a hearing problem cause you difficulty when listening to the television or radio? | ______ | ______ | ______ |
| Do you feel that whatsoever difficulty with your hearing limits or hampers your personal or social life? | ______ | ______ | ______ |
| Does a hearing trouble cause you difficulty when in a restaurant with relatives or friends? | ______ | ______ | ______ |
| Raw score (sum of the points assigned to each of the items) | ______ |
URINARY CONTINENCE
Urinary incontinence, the unintentional leakage of urine, affects approximately 15 one thousand thousand persons in the United States, nearly of whom are older.24 Urinary incontinence has important medical repercussions and is associated with decubitus ulcers, sepsis, renal failure, urinary tract infections, and increased mortality. Psychosocial implications of incontinence include loss of self-esteem, brake of social and sexual activities, and low. Additionally, incontinence is often a key deciding factor for nursing home placement.25 An cess for urinary incontinence should include the evaluation of fluid intake, medications, cognitive function, mobility, and previous urologic surgeries.xiv The single all-time question to ask when diagnosing urge incontinence is, "Do y'all take a strong and sudden urge to void that makes y'all leak before reaching the toilet?" (positive likelihood ratio = four.2; negative likelihood ratio = 0.48). A proficient question to ask when diagnosing stress incontinence is, "Is your incontinence caused past cough, sneezing, lifting, walking, or running?" (positive likelihood ratio = ii.2; negative likelihood ratio = 0.39).26
BALANCE AND FALL PREVENTION
Dumb rest in older persons oft manifests every bit falls and fall-related injuries. Approximately one-3rd of community-living older persons fall at least one time per twelvemonth, with many falling multiple times.27,28 Falls are the leading crusade of hospitalization and injury-related death in persons 75 years and older.29
The Tinetti Residue and Gait Evaluation is a useful tool to assess a patient's fall take chances.28,30 This test involves observing as a patient gets upwards from a chair without using his or her arms, walks 10 ft, turns around, walks dorsum, and returns to a seated position. This entire process should have less than 16 seconds. Those patients who have difficulty performing this exam have an increased risk of falling and need further evaluation.31
Older persons can decrease their fall adventure with practice, physical therapy, a home take chances assessment, and withdrawal of psychotropic medications. Guidelines addressing autumn prevention in older persons living in nursing homes have been published by the American Medical Directors Association and the American Geriatrics Society.32,33
OSTEOPOROSIS
Osteoporosis may outcome in low-touch or spontaneous fragility fractures, which can atomic number 82 to a fall.14 Osteoporosis can be diagnosed clinically or radiographically.34 It is near commonly diagnosed by dual-energy x-ray absorptiometry of the full hip, femoral neck, or lumbar spine, with a T-score of –ii.v or below.35,36 The USPSTF has advised routinely screening women 65 years and older for osteoporosis with dual-energy x-ray absorptiometry of the femoral neck.37
POLYPHARMACY
Polypharmacy, which is the utilize of multiple medications or the assistants of more medications than clinically indicated, is mutual in older persons. Among older adults, 30 percentage of infirmary admissions and many preventable problems, such as falls and confusion, are believed to be related to adverse drug furnishings.38 The Centers for Medicare and Medicaid Services encourages the apply of the Beers criteria, which listing medication and medication classes that should be avoided in older persons, as part of an older patient's medication assessment to reduce adverse furnishings.39,40 In 2003, a consensus panel of experts revised the criteria.41 The Beers criteria tin be found at http://www.dcri.knuckles.edu/ccge/curtis/beers.html.
Cognition and Mental Wellness
- Abstruse
- Functional Ability
- Physical Health
- Noesis and Mental Health
- Socioenvironmental Circumstances
- Problem List
- References
DEPRESSION
The USPSTF recommends screening adults for low if systems of care are in place.42 Of the several validated screening instruments for low, the Geriatric Depression Calibration and the Hamilton Low Scale are the easiest to employ and nigh widely accepted.43 However, a simple ii-question screening tool ("During the past calendar month, accept yous been bothered by feelings of sadness, depression, or hopelessness?" and "Accept you oft been bothered past a lack of interest or pleasance in doing things?") is every bit effective equally these longer scales.43,44 Responding in the affirmative to one or both of these questions is a positive screening test for low that requires further evaluation.
DEMENTIA
Early on diagnosis of dementia allows patients timely admission to medications and helps families to make preparations for the futurity. It can also assistance in the management of other symptoms that often back-trail the early stages of dementia, such as depression and irritability. As few as 50 percent of dementia cases are diagnosed past physicians.45 There are several screening tests available to assess cognitive dysfunction; even so, the Mini-Cognitive Cess Instrument is the preferred examination for the family unit md because of its speed, convenience, and accurateness, as well as the fact that information technology does not require fluency in English (Table six46,47).
Table 6
Mini-Cognitive Assessment Musical instrument
| Footstep 1. Ask the patient to repeat three unrelated words, such as "ball," "domestic dog," and "window." |
| Footstep 2. Ask the patient to draw a simple clock set up to 10 minutes afterward eleven o'clock (11:ten). A correct response is drawing of a circle with the numbers placed in approximately the right positions, with the hands pointing to the 11 and 2. |
| Step 3. Inquire the patient to recall the three words from Step i. One point is given for each item that is recalled correctly. |
| Interpretation |
| Number of items correctly recalled | Clock drawing test event | Interpretation of screen for dementia |
|---|---|---|
| 0 | Normal | Positive |
| 0 | Abnormal | Positive |
| ane | Normal | Negative |
| 1 | Abnormal | Positive |
| 2 | Normal | Negative |
| two | Abnormal | Positive |
| 3 | Normal | Negative |
| 3 | Abnormal | Negative |
Socioenvironmental Circumstances
- Abstract
- Functional Ability
- Concrete Health
- Noesis and Mental Health
- Socioenvironmental Circumstances
- Trouble List
- References
According to the U.S. Census Bureau, approximately lxx percent of noninstitutionalized adults 65 years and older live with their spouses or extended family, and 30 percentage alive alone.48 Determining the most suitable living arrangements for older patients is an important function of the geriatric assessment. Although options for housing for older persons vary widely, there are 3 basic types: private homes in the community, assisted living residences, and skilled nursing facilities (e.g., rehabilitation hospitals, nursing homes). Factors affecting the patient's socioenvironmental circumstances include their social interaction network, available support resources, special needs, and ecology safe.
Problem List
- Abstruse
- Functional Power
- Physical Health
- Noesis and Mental Health
- Socioenvironmental Circumstances
- Problem List
- References
As cess data are obtained, they need to exist recorded to allow all members of the health intendance squad to easily access the information. The family doctor can generate a problem list that includes any condition or event requiring new or ongoing care; the medical, nutritional, functional, and social implications; and proposed interventions. This blazon of assessment allows older patients to do good from an interdisciplinary team that is effectively assessing and actively managing their health care.
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