Table 1 Geriatric assessment chart
Target problem | Diagnostic test | Cut-off value | Management strategies |
|---|---|---|---|
Visual acuity | Jaeger's test [37] | ≤20/40 | Referral to ophthalmologist |
Hearing acuity | Whisper test [38] | Failure to correctly repeat 3 whispered numbers | Removal of ear wax Referral to otolaryngologist |
Urinary incontinence | IKO-4-Test [39] | 4 defined questions ≥1 question answered positive | Change of existing drug prescription Pelvic floor muscle training Drug treatment Planning of in-depth exploration by GP Referral to urologist or gynaecologist |
Depression | Geriatric depression scale, short version (GDS 4) [33] | 4 defined questions ≥1 question answered positive | New antidepressant drug therapy Change of drug prescription Non-drug treatment strategy Planning of in-depth exploration by GP Referral to psychiatrist |
Cognitive impairment | Memory Assessment Clinics Questionnaire (MAC-Q) [40] | 6 defined questions (Score range 7 – 35) Score ≥25 suggestive of cognitive impairment | Follow-up examination in 6 months¶ Referral for memory assessment to neurologist or psychiatrist |
ADL and IADL †| Katz's ADL scale (4 questions) [41] Two questions from Lawton [42] | Score ≤7 impairment of functioning in daily living (total score 0–9). | Planning of in-depth exploration by GP Referral according to underlying problem |
Psychosocial circumstances | Do you have trustworthy persons giving you assistance at home? [43] | Yes/No | Contact with community nurse, neighbours or relatives |
Sleep disorder | Do you suffer from frequent sleeping problems? | Yes/No | Non-Drug therapy Change of drug prescription Drug treatment Planning of in-depth exploration by GP Referral to psychiatrist/internist. |
Influenza and pneumococcal Immunisation | Influenza vaccination within a one-year period [24] Pneumococcal vaccination within a three-year period [44] | Yes/No | Influenza or pneumococcal vaccination |
Fall risk assessment | History of falls Timed Up and Go Test [45] Tandem – Stand Test [46] | Fall within last 6 months >20 s suggestive of balance or gait difficulties Score 0–4: >1 suggestive of balance or gait difficulty | Exploration of drug prescription Hip protector Source exploration Replacement of footwear initiated Instructed exercise training |
Cardiovascular risk assessment | Lipid profile (mmol/l) [47,48] Blood pressure (mm Hg) [50] Hyperglycemia [51] | Chol > 5.95 mmol/l LDL > 3.36 mmol/l HDL < 1.16 mmol/l TG > 4.6 mmol/l BPsyst > 140 mmHg BPdiast > 80 mmHg Fasting blood glucose > 6.1 mmol/l | Change or onset of antilipidemic drug treatment Change or onset of antihypertensive drug treatment Change or onset of oral antidiabetic drug or insulin |
Medication history | Number of prescribed drugs Number of over the counter medications [43] | >5 prescription drugs >3 over the counter drugs. | Â |
Hospital stay | Hospital stay within a 5-months period [43] | Â | Â |
Nutrition | Body mass index | BMI normal range for the elderly 24 – 29, Waid Guide [52] | Planning of in-depth exploration by GP |
Osteoporosis risk factors | 9 items risk factor checklist [53] | Female sex Prior spontaneous fracture Family history of osteoporosis Immobilisation Premature menopause Glucocorticoid treatment Smoking Alcohol abuse Low body weight | Calcium and Vitamin D Bisphosophonate Selective estrogen-receptor modulator Calcitonin |