Geriatric Psychiatry Interview

Primer

The Geriatric Psychiatry Interview is a specialized psychiatric interview tailored to older adults. It requires a particular focus on cognitive testing, neurological examination, and physical exam. An examination of psychosocial factors is important, in particular with functional status (ADLs and IADLs), family supports, and social isolation.

History of Presenting Illness

Cognition

With cognitive impairment, one should always ask around:

  • Is the individual wandering or getting lost?
  • Leaving food on stove
  • Forgetting to turn off taps

Mood

  • If depressed, ask about somatic delusions and delusions of poverty (common in the elderly)

Anxiety

  • Generalized anxiety, phobias (fear of falling) are common in the elderly

Safety

  • Driving
  • Firearms at home
  • Are there grandchildren in the home who might be at risk?

Geriatric Giants

  • A review of geriatric giants, including: falls (fears of falling), incontinence, polypharmacy, and cognition

Functional Assessment

Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLS) should be reviewed with either the caregiver or the patient to get a sense of the patient's overall function.

ADLs

  • D Dressing
  • E Eating
  • A Ambulation
  • T Transferring/Toileting
  • H Hygiene/Bathing

IADLs

  • S Shopping
  • H Housekeeping/laundry
  • A Accounting (Finances/Banking)
  • F Food preparation and medications
  • T Telephone/Transportation

Scales

Functional Assessment Scales

Name Rater Description Download
Physical Self-Maintenance Scale (PSMS) Patient/Clinician The PSMS is a 6-item scale of ADL and 8-item scale of ADLs. Each item has a 5-point range (total independence to total dependence). The PSMS assesses disability in older adults in the community or an institution.[1] Download
Clinical Frailty Scale (Rockwood) Clinician Summarizes the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician. Download

Family History

  • History of neurodegenerative disorders

Medications

  • Are medications blister packed?
  • What is the medication adherence?
  • Use of any over-the-counter medications, supplements, herbals?

Physical Exam

  • If neurological exam is indicated, do it!
  • In a primary care, specialized psychiatric, or memory clinic for the elderly, the following physical examinations should be done:[2]
    • Physical:
      • Orthostatic vitals
      • Heart rate
      • Malnutrition (weight, BMI)
      • Hygiene
    • Neurologic:
      • Gait exam (looking for features of Parkinsonism, spastic gait, and turning)
      • Motor examination (for tremors, facial masking, bradykinesia, rigidity, cogwheeling, and cerebellar findings)

Investigations

  • If suspecting an underlying neurodegenerative disorder, may order:
    • MRI to look for white matter/subcortical changes, focal atrophy, or structural abnormalities
    • SPECT to look for regions of hypoperfusion

References

1) Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The gerontologist, 9(3_Part_1), 179-186.
2) Heckman, G. A., Franco, B. B., Lee, L., Hillier, L., Boscart, V., Stolee, P., ... & Seitz, D. (2018). Towards consensus on essential components of physical examination in primary care-based memory clinics. Canadian Geriatrics Journal, 21(2), 143.