Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revision Previous revision
Previous revision
teaching:geriatric-psych-interview [on April 30, 2020]
teaching:geriatric-psych-interview [on July 3, 2023] (current)
psychdb [Cognition]
Line 5: Line 5:
 {{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|]]** and **[[geri:dementia:​home|]]**</​alert>​ 
-  * Atrial fibrillation + 
-    Pacemaker +With cognitive impairment, one should always ask around
-  * TIAs +  * Is the individual wandering or getting lost? 
-  * Stroke +  * Leaving food on stove 
-===== Function ​===== +  * Forgetting to turn off taps 
-Activities of daily living ​(ADLS) and instrumental activities ​of daily living ​(IADLS) should be reviewed with either the caregiver or the patient.+==== 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 [[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 38:
   * ''​E''​ Eating   * ''​E''​ Eating
   * ''​A''​ Ambulation   * ''​A''​ Ambulation
-  * ''​T'' ​Transfering +  * ''​T'' ​Transferring/​Toileting 
-  * ''​H''​ Hygiene+  * ''​H''​ Hygiene/Bathing
  
 </​WRAP>​ </​WRAP>​
Line 31: Line 45:
 ==== 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}}