A Geriatric Assessment Instrument
Domain (1) | Item |
|---|---|
Degree of difficulty eating, dressing, bathing, transferring between bed and chair, using the toilet, and controlling bladder and bowel Degree of difficulty preparing meals, doing housework, taking medications, going on errands (eg, shopping), managing finances, and using the telephone | |
Assistive devices | Use of personal devices (eg, cane, walker, wheelchair, oxygen) Use of environmental devices (eg, grab bars, shower bench, hospital bed) |
Caregivers | Use of paid caregivers (eg, nurses, aides) Use of unpaid caregivers (eg, family members, friends, volunteers) |
Medications | Name of prescription medications used Name of nonprescription medications used |
Nutrition | Height, weight Stability of weight (eg, "Has the patient lost 4.54 kg [10 lb] in the past 6 months without trying?") |
Preventive measures | Regularity of blood pressure measurements, guaiac test for occult blood in stool, sigmoidoscopy or colonoscopy, immunizations (influenza, pneumococcal, tetanus), thyroid-stimulating hormone assessment, and dental care Regularity of exercise Use of smoke detectors |
Cognition | Ability to remember 3 objects after 1 minute and draw a clock face (Mini-Cog©) |
Affect | Feelings of sadness, depression, or hopelessness Lack of interest or pleasure in doing things |
Advance directives | Possession of a living will Establishment of durable power of attorney for health care |
Substance abuse/misuse | |
Gait and balance | Number of falls in the past 6 months Time required to rise from a chair, walk 3.05 meters (10 feet), turn around, return, and sit down Extent of maximal forward reach while standing |
Sensory function | Ability to report 3 numbers whispered 0.61 meters (2 feet) behind the head Ability to read Snellen chart at 20/40 or better (with corrective lenses, if needed) |
Upper extremity mobility | Ability to clasp hands behind the head and back |