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When multiple concerns are presented, the use of a “rolling” assessment over several visits should be considered.
Approximately one-half of the ambulatory primary care for adults older than 65 years is provided by family physicians,1 and approximately 22 percent of visits to family physicians are from older adults.23 It is estimated that older adults will comprise at least 30 percent of patients in typical family medicine outpatient practices, 60 percent in hospital practices, and 95 percent in nursing home and home care practices.4A complete assessment is usually initiated when the physician detects a potential problem such as confusion, falls, immobility, or incontinence.
The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person's functional ability, physical health, cognition and mental health, and socioenvironmental circumstances.
Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed.
Social and psychological factors may also mask classic disease presentations.
For example, although 30 percent of adults older than 85 years have dementia, many physicians miss the diagnosis.56 Thus, a more structured approach to assessment can be helpful.
Specific elements of physical health that are evaluated include nutrition, vision, hearing, fecal and urinary continence, and balance.
The geriatric assessment aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement.