Overview
The major purpose of a Geriatric Assessment is to improve the quality of life for older adults. The assessment identifies problems that an older person might have and then makes specific suggestions about how to treat and help the problems. In general, multiple issues are identified and the process of management includes more than one type of health care provider. A comprehensive Geriatric Assessment usually involves an interdisciplinary team where several providers come together to develop a plan for one individual.
The Geriatric Assessment Team might include but not be restricted to:
- Geriatrician,
- Geriatric Nurse Practitioner or Geriatric Clinical Nurse Specialist,
- Social Worker,
- Physical Therapist,
- Occupational Therapist,
- Pharmacist,
- Psychiatrist,
- Dietician,
Components of a Geriatric Assessment
Generally, any older person with concerns about one or more of the following will benefit from a Geriatric Assessment:
- Multiple Medical Problems,
- Incontinence,
- Malnutrition,
- Medication: the use of multiple medications and compliance issues,
- Sensory Impairment: problems with hearing and vision,
- Cognitive Impairment: dementia/delirium,
- Depression,
- Multiple falls or balance problems,
- Foot Problems,
- Decrease in functional abilities,
- Dental Problems,
- Caregiver Stress, and/or
- Social and Economic Problems.
During the assessment, the team will evaluate each of the areas mentioned above. The initial evaluation of a patient who needs a Geriatric Assessment is usually done by a Geriatrician or a Geriatric Nurse Practitioner. The tools used in the assessment depend upon the major concerns that you or your caregiver identify. Some common ways of evaluating the overall health and functioning of an older adult include:
Activities of Daily Living Evaluation (ADLs)
ADLs are a commonly used health care term to describe the tasks that we all do in our daily lives: eating, bathing, dressing, going to the bathroom, and moving from a bed to a chair or from a chair to a bed (also called transferring).
In a geriatric assessment, a geriatrician will observe your ability to perform or simulate these activities. Observing your ADLs can reveal a lot to your health care provider about physical or mental impairments as well as help them see whether there are other types of care that might be beneficial to you such as physical or occupational therapy.
Instrumental Activities of Daily Living (IADLs)
Geriatricians also look at a series of activities called Instrumental Activities of Daily Living (IADLs). IADLs require a higher level of mental functioning than ADLs, such as using the telephone, shopping, paying bills, balancing a checkbook, and other tasks. At the Geriatric Assessment, your provider will also evaluate your ability to perform IADLs.
Cognitive Assessment
An important third component in a geriatric assessment is a cognitive assessment, which includes a thorough evaluation of memory using several validated questionnaires.
Additional assessments include medication assessment and fall risk. Other evaluation instruments will depend upon your primary areas of concern. After testing and screening are completed, a treatment plan is designed for you. You will be referred back to your primary health care provider once the assessment is completed. You and your primary health care provider will implement and monitor the recommendations made during the Geriatric Assessment.
Cost and Coverage
If an acceptable diagnosis is given, Medicare Part B or Part C will usually cover 80% of the physician's costs associated with the Geriatric Assessment. Medicare does not cover physical exams. You are responsible for the remaining 20% of the approved amount of the bill after the annual deductible has been satisfied. Medicare will also pay for physical or occupational therapy if there is a referral from a physician. If there is a social worker involved as the case manager or coordinator of services, Medicare will not cover those costs, however, individuals with Medigap policies usually have those costs covered.
Consumer Tips
- Older adults may often see several different health care providers, each for something specific and seemingly unrelated. Furthermore, the average older adult is taking 4 or 5 prescription medications as well as over-the-counter drugs or vitamin/herbal supplements. A Geriatric Assessment examines all of these details in the context of your life and history. The Geriatrician is trained to communicate with other health care providers and orchestrate a unified approach to your health needs. Because of this holistic approach, it is critical that a spouse or primary caregiver participate in the geriatric assessment. Caregivers hold a unique perspective that can help the physician or assessment team better understand the bigger picture.
- Prior to your initial assessment visit, spend some time talking with your caregiver about your immediate concerns. Try to think in as much detail as possible, about when the specific trouble started and how it is impacting your life. If you are having difficulty doing things such as walking, driving, or moving on your own or "like you used to", write that down and bring the list to your appointment.
- A Geriatric Assessment may require multiple visits.
Author: Joseph James, M.D.