- Last edited on July 3, 2023
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teaching:geriatric-psych-interview [on April 25, 2020] |
teaching:geriatric-psych-interview [on July 3, 2023] psychdb [Investigations] |
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| {{INLINETOC}} | {{INLINETOC}} | ||
| ===== Primer ===== | ===== Primer ===== | ||
| - | ===== Cognition ===== | + | The **Geriatric Psychiatry Interview** is a specialized [[teaching:1-psych-interview|psychiatric interview]] tailored to older adults. It requires a particular focus on [[:cognitive-testing|cognitive testing]], [[neurology:neuro-exam:home|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. |
| - | ===== Family History ===== | + | |
| - | Risk factors for vascular dementia: | + | |
| - | * Hypertension | + | ===== History of Presenting Illness ===== |
| - | * Dyslipidemia | + | ==== Cognition ==== |
| - | * Coronary Artery Disease | + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See section: **[[:cognitive-testing|]]**</alert> |
| - | * Atrial fibrillation | + | With cognitive impairment, one should always ask around: |
| - | * Pacemaker | + | * Is the individual wandering or getting lost? |
| - | * TIAs | + | * Leaving food on stove |
| - | * Stroke | + | * Forgetting to turn off taps |
| - | ===== Function ===== | + | ==== Mood ==== |
| - | Activities of daily living (ADLS) and instrumental activities of daily living (IADLS) should be reviewed with either the caregiver or the patient. | + | * 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 [[geri:1-giants|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. | ||
| <WRAP group> | <WRAP group> | ||
| <WRAP half column> | <WRAP half column> | ||
| Line 24: | Line 37: | ||
| * ''E'' Eating | * ''E'' Eating | ||
| * ''A'' Ambulation | * ''A'' Ambulation | ||
| - | * ''T'' Transfering | + | * ''T'' Transferring/Toileting |
| - | * ''H'' Hygiene | + | * ''H'' Hygiene/Bathing |
| </WRAP> | </WRAP> | ||
| Line 31: | Line 44: | ||
| ==== IADLs ==== | ==== IADLs ==== | ||
| * ''S'' Shopping | * ''S'' Shopping | ||
| - | * ''H'' Housework/Hobbies | + | * ''H'' Housekeeping/laundry |
| * ''A'' Accounting (Finances/Banking) | * ''A'' Accounting (Finances/Banking) | ||
| - | * ''F'' Food | + | * ''F'' Food preparation and medications |
| - | * ''T'' Telephone/Tools | + | * ''T'' Telephone/Transportation |
| </WRAP> | </WRAP> | ||
| </WRAP> | </WRAP> | ||
| + | ==== Scales ==== | ||
| + | <panel title="Functional Assessment Scales" no-body="true"> | ||
| + | ^ 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.[([[https://pubmed.ncbi.nlm.nih.gov/5349366/|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.]])] | {{ :teaching:psms.pdf |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. | {{:teaching:rockwood-clinical-frailty-scale.pdf|Download }} | | ||
| + | </panel> | ||
| + | |||
| + | ===== Family History ===== | ||
| + | * History of neurodegenerative disorders | ||
| + | * [[geri:dementia:alzheimers|Alzheimer's]] | ||
| + | * [[geri:parkinsons|Parkinson's]] | ||
| + | * Family risk factors for [[geri:dementia:vascular|vascular dementia]] | ||
| + | * Hypertension | ||
| + | * Dyslipidemia | ||
| + | * Coronary Artery Disease | ||
| + | * Atrial fibrillation | ||
| + | * Pacemaker placement? | ||
| + | * TIAs | ||
| + | * Stroke | ||
| + | |||
| + | ===== Medications ===== | ||
| + | * Are medications blister packed? | ||
| + | * What is the medication adherence? | ||
| + | * Use of any over-the-counter medications, supplements, herbals? | ||
| + | ===== Physical Exam ===== | ||
| + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See main article: **[[neurology:neuro-exam:home|]]**</alert> | ||
| + | * If [[:neurology|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:[([[http://www.cgjonline.ca/index.php/cgj/article/view/296/397|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.]])] | ||
| + | * **Physical**: | ||
| + | * Orthostatic vitals | ||
| + | * Heart rate | ||
| + | * Malnutrition (weight, BMI) | ||
| + | * Hygiene | ||
| + | * **Neurologic**: | ||
| + | * Gait exam (looking for features of [[geri:parkinsons|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: | ||
| + | * [[neurology:mri|MRI]] to look for white matter/subcortical changes, focal atrophy, or structural abnormalities | ||
| + | * [[neurology:spect|SPECT]] to look for regions of hypoperfusion | ||
| + | |||
| {{tag>interview}} | {{tag>interview}} | ||