Post on 15-Feb-2022
Gateway Geriatric
Education Center
Saint Louis University
Division of Geriatric Medicine
Enhancing Geriatric Care by
Primary Care Health
Professionals
“The trouble is, old age is not interesting until
one gets there. It is a foreign country with an
unknown language to the young and even the
middle-aged.”
-May Sarton
-As We Are Now
Geriatric Workforce
Decline in Geriatricians in the United States
1988 2030
Geriatricians 7,128 7,750
Geriatricians
per older adult
1 for
every
2,546
1 for
every
4,254
Geropsychiatrists 1,596 1,659
Geriatric Assessment
• Geriatric Assessment is a systematic, interprofessional
approach to the older patient
– Diagnose geriatric syndromes
– Develop targeted treatment plans
– Improve patient outcomes
• Focus on function and quality of life
• Not based on chronological age but functional impairment
and risk of future decline
N Engl J Med. 1984 Dec 27;311(26):1664-70.
Effectiveness of a geriatric evaluation unit. A randomized clinical trial.
Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL.
At one year, patients who had been assigned
to the geriatric unit had much lower mortality
than controls (23.8 vs. 48.3 per cent, P less
than 0.005) and were less likely to have initially
been discharged to a nursing home (12.7 vs.
30.0 per cent, P less than 0.05) or to have
spent any time in nursing home (26.9 vs.
46.7 per cent, P less than 0.05).
Effect of inpatient rehabilitation specifically designed for geriatric patients on functional improvement and mortality at hospital discharge and at follow-up.
Stefan Bachmann et al. BMJ 2010;340:bmj.c1718©2010 by British Medical Journal Publishing Group
Function Mortality
Effect of inpatient rehabilitation specifically designed for geriatric patients on admissions to nursing homes at hospital discharge and at follow-up.
Stefan Bachmann et al. BMJ 2010;340:bmj.c1718
©2010 by British Medical Journal Publishing Group
J Am Geriatr Soc. 1999 Mar;47(3):269-76.
A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an
intervention to increase adherence to recommendations.
Reuben DB1, Frank JC, Hirsch SH, McGuigan KA, Maly RC.
• Physical functioning between treatment and control
groups indicated a significant benefit of treatment (P =
.021).
• Similar benefits were demonstrated for number of
restricted activity days and MOS SF-36 energy/fatigue,
social functioning, and physical health summary scales.
• The intervention, which prevented functional decline, cost
$273 per participant.
Yearly "Wellness" visits:
• If you've had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan to prevent disease and disability based on your current health and risk factors.
• Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit
• A review of your medical and family history• Developing or updating a list of current providers and prescriptions• Height, weight, blood pressure, and other routine measurements• Detection of any cognitive impairment• Personalized health advice• A list of risk factors and treatment options for you• A screening schedule (like a checklist) for appropriate preventive services.
Medicare
Annual Wellness Visit
Modern Giants of Geriatrics
Frailty
Sarcopenia
Anorexia of Aging
Cognitive Impairment
Rapid Geriatric Assessment
• Early detection of health problems when interventions are
most likely to be successful
• Used for common geriatric problems
• Ideally provide a brief, reliable method for detecting
common problems
• Track changes over time
How to Bill Medicare’s Annual Wellness Visit (AWV)
Diagnosis code V70.0; Initial Annual Wellness Visit
G0438; Subsequent Annual Wellness Visit G0439
Saint Louis University
Rapid Geriatric Assessment*
Miscellaneous
Are you constipated? Y/N
Do you have worrisome incontinence? Y/N
Do you have an advanced directive? Y/N
*There is no copyright on these screening tools and they may be
incorporated into the Electronic Health Record without permission and at no cost.
SNAQ (Simplified Nutritional Assessment Questionnaire)
My appetite is Food tastes
a. very poor a. very bad
b. poor b. bad
c. average c. average
d. good d. good
e. very good e. very good
When I eat Normally I eat
a. I feel full after eating a. less than one meal a day
only a few mouthfuls b. one meal a day
b. I feel full after eating c. two meals a day
about a third of a meal d. three meals a day
c. I feel full after eating e. more than three meals a day
over half a meal
d. I feel full after eating
most of the meal
e. I hardly ever feel full
__________________________________From Wilson et al. Am J Clin Nutr 2005;82:1074-81.
Rapid Cognitive Screen (RCS)
1. Please remember these five objects. I will ask you what they
are later. [Read each object to patient using approx. 1 second
intervals.]
Apple Pen Tie House Car
2. [Give patient pencil and the blank sheet with clock face.] This is a
clock face. Please put in the hour markers and the time at ten
minutes to eleven o’clock. [2 pts/hr markers ok; 2 pts/time correct]
3. What were the five objects I asked you to remember? [1 pt/ea]
4. I’m going to tell you a story. Please listen carefully because
afterwards, I’m going to ask you about it.
Jill was a very successful stockbroker. She made a lot of money on the stock
market. She then met Jack, a devastatingly handsome man. She married him
and had three children. They lived in Chicago. She then stopped work and
stayed at home to bring up her children. When they were teenagers, she went
back to work. She and Jack lived happily ever after.
What state did she live in? [1 pt]
______________________________________________
From MalmstromTK, Voss VB, Cruz-Oliver DM et al.
J Nutr Health Aging 2015;19:741-744.
The Simple “FRAIL” Questionnaire Screening Tool
(3 or greater = frailty; 1 or 2 = prefrail)
Fatigue: Are you fatigued?
Resistance: Cannot walk up one flight of stairs?
Aerobic: Cannot walk one block?
Illnesses: Do you have more than 5 illnesses?
Loss of weight: Have you lost more than 5% of your weight
in the last 6 months?
_________________________________________________From Morley JE, Vellas B, Abellan van Kan G, et al. J Am Med Dir Assoc
2013;14:392-397.
Table I: SARC-F Screen for Sarcopenia
Component Question Scoring_________
Strength How much difficulty do you have in None = 0
lifting and carrying 10 pounds? Some = 1
A lot or unable = 2
Assistance in How much difficulty do you have None = 0
walking walking across a room? Some = 1
A lot, use aids, or unable = 2
Rise from a How much difficulty do you have None = 0
chair transferring from a chair or bed? Some = 1
A lot or unable without help = 2
Climb stairs How much difficulty do you have None = 0
climbing a flight of ten stairs? Some = 1
A lot or unable = 2
Falls How many times have you None = 0
fallen in the last year? 1-3 falls = 1
4 or more falls = 2
From Malmstrom TK, Morley JE. J Frailty and Aging 2013;2:55-6.
FRAILTY DEFINITIONS
“Occurs when under stressful conditions the person has
diminished ability to carry out important practiced
social activities of daily living.It needs to be distinguished
from disability”
Renoir, 1915
Blonde a la rosa
0 10 20 30 40 50 60 70 80 90 100
Age (years)
Cogn
itiv
e R
eser
ve
VO
2 m
ax
Car
dia
c outp
ut
Bal
ance
Musc
le s
tren
gth
Frailty
Threshold
Frailty CascadePSYCHOLOGICAL
Depression
Cognition
Anxiety
Fear of Falling
Fatigue
Health Perception
SOCIAL
Environment
Income
Support System
Health Literacy
Activity
BIOLOGICAL
Genetics
Muscle
Hormones
Cytokines
Disease
Deficits
FRAILTY
Functional Deficit
(IADLs/ADLs)
Hospitalisation
Nursing Home
Death
Fatigue
Resistance (1 flight stairs)
Aerobic (1 block)
Illnesses (>5)
Loss of weight (5%)
Criteria of
Internationl Academy of Nutrition and Aging, 2008
9-year OR of ADL deficit or Mortality
in persons not lacking ADLsADLs
PreFrail Frail p
FRAIL 2.74 20.76 .001
SOF 3.09 3.48 .001
CHS 2.40 6.47 .001
Rockwood 2.36 5.65 .001
MORTALITY
PreFrail Frail p
1.58 3.99 .001
1.47 1.40 NS
1.35 2.42 .01
2.50 2.66 .001
Specificity of Scales in
Hong Kong Study
MALE MALE FEMALE FEMALE
MORTALITY Physical Limit MORTALITY Physical Limit
Rockwood 96.4% 98.4% 93.8% 98%
CHS 99.2% 100% 99.4% 99.9%
FRAIL 99.1% 99.4% 99.9% 100%
Hubbard 98% 99.6% 96.1% 95.1%
All had poor Sensitivity
Algorithm for Management of Frailty
Fatigue
Resistance Aerobic
Illnesses
Loss of Weight
SLU “AM SAD” for depressionDo you stop breathing while asleep? Sleep apneaTSH for hypothyroidVitamin B12Hemoglobin for anemiaBlood pressure for hypotension/orthostasis
SARCOPENIA
Resistance exerciseAerobic exerciseProtein supplement daily1000 IU vitamin D daily
3 to 5 x week
Review medication list for unnecessary side effects and drugs whose side effects may be contributing to frailty, e.g., anticholinergic drugs
Medications producing anorexiaEmotional – depressionAbuse, elderly, alcoholismLate life paranoiaSwallowing problemsOral problemsNosocomial infections, eg, H PyloriWandering and other dementia-related problemsHyperthyroidism, hypercalcemia, hyperglycemia, hypoadrenalismEnteral problems, eg, celiac diseaseEating problemsLow salt, sugar and cholesterol dietsStones - cholecystitis
Caloric Supplementation
The American Journal of MedicineVolume 128, Issue 11, November 2015, Pages 1225–1236.e1
Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A
Randomized Controlled Trial
Tze Pin Ng, MDa, , , Liang Feng, PhDa, Ma Shwe Zin Nyunt, PhDa, Lei Feng, PhDa, Mathew Niti, PhDb, Boon Yeow Tan, MMEDc, Gribson Chan, MScc, Sue
Anne Khoo, MPsych(Clin)d, Sue Mei Chan, MHlthSc (Mgmt)d, Philip Yap, MRCPd, Keng Bee Yap, FRCP(Edin)e
Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial
The American Journal of Medicine, Volume 128, Issue 11, 2015, 1225–1236.e1
Results
Frailty score and status over 12 months were reduced in all groups,
including control (15%), but were significantly higher (35.6% to 47.8%) in
the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical
(OR 4.05) and combination (OR 5.00) intervention groups.
Beneficial effects were observed at 3 months and 6 months, and persisted
at 12 months.
Improvements in physical frailty domains (associated with interventions)
were most evident for knee strength (physical, cognitive, and combination
treatment), physical activity (nutritional intervention), gait speed (physical
intervention), and energy (combination intervention).
Conclusions
Physical, nutritional, and cognitive interventional approaches were
effective in reversing frailty among community-living older persons.
Is frailty among older individuals reversible
with nutritional, physical, or cognitive interventions, singly or in combination?
WARM-UP a PROPRIOCEPTION/BALANCE EXERCISES d STRETCHING
b AEROBIC TRAINING
c STRENGTH TRAINING
20R each arm
1
20R each arm
2
20R each foot
3
4
20R each leg
5
20R each leg
30s each leg
20R each leg
5
20R 20R
30s each foot in front
30s each foot in front nt
30s
6 7 8
30s each leg
4
1 1
20s each side
2
20s
3
20R forward + 20R back
5
20R each leg
20s each hand
4
6
2R x 20s each leg
3
20R
After 10 minutes After first 5 minutes 2
20R
After 15 minutes 4
Top 2 steps Walking
1
WITH ELASTIC BANDS
1 2 3 2 1 3
WITH BIG BALLS WITH SMALL BALLS
1 2 3
2 3
Tarazona-Santabalbina FJ, Gomez-Cabrera MC, Perez-Ros P et al. A Multicomponent exercise intervention that reverses frailty and improves cognitiion, emotional, and social networking in the community-dwelling frail elderly. A randomized clinical trial. J Am Med Dir Assoc 2016 (In press).
A multicomponent exercise intervention that reverses frailty
Tarazona-Santabalina et al, JAMDA In pressFried Frailty Criteria
0
0.5
1
1.5
2
2.5
3
3.5
4
Control Exercise
Basal Post
SPPB
0
1
2
3
4
5
6
7
8
9
10
Control Exercise
Basal Post
J Am Med Dir Assoc. 2015 May 1;16(5):439.e9-439.e16. doi: 10.1016/j.jamda.2015.02.005. Epub 2015 Apr 2.
Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status,
and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study.
Abizanda P1, López MD2, García VP3, Estrella Jde D4, da Silva González Á5, Vilardell NB6, Torres KA6.
Author information
Abstract
OBJECTIVES:
The objective of this study was to assess the effects of a hyperproteic, hypercaloric oral nutritional supplement with prebiotic fiber, vitamin D, and calcium, plus a standardized
physical intervention, in the functional status, strength, nutritional status, and quality of life of frail institutionalized older adults.
DESIGN:
Multicentric prospective observational study under usual clinical practice conditions.
SETTING:
Four nursing homes from Burgos (2), Albacete, and Madrid, Spain.
PARTICIPANTS:
Participants included 91 institutionalized older adults (age ≥70), able to walk 50 m, and meeting at least 3 of the Fried frailty phenotype criteria.
INTERVENTION:
Daily intake of two 200-mL bottles of an oral nutritional supplement, each bottle containing 300 kcal, 20 g protein, 3 g fiber, 500 IU vitamin D, and 480 mg calcium, plus a
standardized physical exercise training consisting of flexibility, balance, and strengthening exercises for arms and legs, 5 days per week.
MEASUREMENTS:
Short Physical Performance Battery (SPPB), Short-Form-Late-Life Function and Disability Instrument (SF-LLFDI) function subscale, handgrip strength, EuroQoL-5 Dimensions
visual analogic scale (EQ5DVAS), weight, body mass index (BMI), and Short-Form Mini Nutritional Assessment (MNA-SF) at baseline and 6 and 12 weeks.
RESULTS:
Forty-eight participants (52.7%) improved at least 1 point in the SPPB at week 6, and 44 (48.4%) did so at week 12; 39 participants (42.9%) improved at least 2 points in the SF-
LLFDI at week 6, and 46 (50.5%) at week 12. Participants improved their quality of life measured with the EQ5DVAS by 6% (95% confidence interval [CI] 3%-10%) at week 6, and
by 5% (95% CI 0%-10%) at week 12. They also improved their nutritional status (weight gain, BMI increase, and higher MNA-SF scores at 6- and 12-week follow-up). This
improvement was higher in participants with more frailty criteria, lower functional level, lower vitamin D levels, and poorer nutritional status.
CONCLUSION:
A 12-week intervention with oral nutritional supplementation plus physical exercise improves function, nutritional status, and quality of life in frail institutionalized older adults.
Frailty
n=4461
Participants with a total score higher than 4 were classified as having sarcopenia
Physical function as independent predictors of SARC-F ≥ 4 in multiple binary
logistic regression analysis
n B S.E. P OR 95% C.I. for OR
4m walking speed 202 -4.913 .851 .000 .007 0.001-0.039
TUG* completed 76 -4.018 .781 .000 .018 0.004-0.083
TUG time 25 .071 .022 .001 1.074 1.029-1.121
SPPB#
76 -.572 .084 .000 .565 0.479-0.665
Grip strength 28 -.139 .025 .000 .870 0.828-0.915
SARC-F CHENGDU
St Louis SARC-F Longitudinal
SARC-F in Baltimore Longitudinal Study
60+ years
Odds Ratio P-value
Gait Speed<0.8 m/s
9.41(2.51-35.27) 0.001
Mortality 3.07(1.60-5.73) 0.001
SARC-F
Odds Ratio for 4 year outcomes associated with
different sarcopenia definitions
Woo et al: Hong Kong Data
Males Females
Sarcopenia and DiabetesAfrican Americans 50 - 65 years
Diabetics who were SARC-F positive had a high risk of future ADL and IADL deficits
Kentaro Kamiya
Treatment for SARCOPENIA is
RESISTANCE EXERCISE
PROVIDE (PROTEIN) STUDY CENTRESACROSS EUROPE
Sarcopenia in SLU Diabetic ClinicSarcopenia(SARC-F) in Diabetic
Outpatients 6 months outcomes
• Hospital Utilisation:
3.735(1.649-8.458)
p<0.002
• Disability:
4.237(1.764-10.181)
p<0.001
Sarcopenia
n=4461
1) My appetite is1. Very poor
2. Poor
3. Average
4. Good
5. Very good
2) When I eat, I feel full after
1. Eating only a few mouthfuls
2. Eating about a third of a plateful
3. Eating over half a plateful
4. Eating most of the food
5. Hardly ever
3) Food tastes1. Very bad2. Bad3. Average4. Good5. Very good
4) Normally I eat
1. Less than one full meal a day
2. One meal a day
3. Two meals a day
4. Three meals a day
5. More than three meals a day, including snacks
S.N.A.Q
< 15 predicts significant
weight loss within 6 months
Mini-CNAQ: 5% weight loss
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
1-Specificity
Se
nsi
tiv
ity
Area Under Curve = 0.85, P < .001
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
1-Specificity
Sen
siti
vity
Area Under Curve = 0.87, P < .001
Total
old
0.0
0.2
0.4
0.6
0.8
1.0
0.0 0.2 0.4 0.6 0.8 1.0
1-Specificity
Sens
itivi
ty
Area Under Curve = 0.84, P < .001
young
SNAQ
Sensitivity
(%)
Specificity
(%)
5% weight loss 81.3 76.4
10% weight loss 88.2 83.5
Geriatr Gerontol Int. 2014 Dec 16. doi: 10.1111/ggi.12426. [Epub ahead of print]Reliability and validity of the Japanese version of the simplified nutritional appetite questionnaire in
community-dwelling older adults.Nakatsu N1, Sawa R1, Misu S1,2, Ueda Y1, Ono R1.
• The mean score of the Japanese version of the SNAQ was 15.5, with a Cronbach's alpha coefficient of 0.545 and intraclasscorrelation coefficient of 0.754.
• Factor analysis showed a single factor with 50.0% explained variance.
• The SNAQ was significantly associated with the Mini-Nutritional Short Form
• SNAQ (Japanese version) is useful for evaluating the appetite of community-dwelling older adults in Japan.
Fig. 2. Discriminate Simplified Nutritional Assessment Questionnaire (SNAQ) value for determining older people with or without a normal Mini-Nutritional
Assessment (MNA) (receiver operating characteristic [ROC] curve).
Yves Rolland, Amélie Perrin, Virginie Gardette, Nadège Filhol, Bruno Vellas
Screening Older People at Risk of Malnutrition or Malnourished Using the Simplified Nutritional Appetite Questionnaire (SNAQ): A Comparison With
the Mini-Nutritional Assessment (MNA) Tool
Journal of the American Medical Directors Association, Volume 13, Issue 1, 2012, 31–34
http://dx.doi.org/10.1016/j.jamda.2011.05.003
Measuring Appetite with the Simplified Nutritional
Appetite Questionnaire Identifies Hospitalised
Older People at Risk of Worse Health Outcomes
A.L. PILGRIM,1,2 D. BAYLIS,1 K.A. JAMESON,2 C.
COOPER,2 A.A. SAYER,1,2,3,4 S.M.
ROBINSON,1,2 and H.C. ROBERTS1,2,3,4
179 female participants mean age 87 (SD 4.7) years were
recruited
42% of participants had a low SNAQ score (<14,
indicating poor appetite).
A low SNAQ score was associated with an increased risk
of hospital acquired infection (OR 3.53; 95% CI: 1.48,
8.41; p=0.004) and with risk of death (HR 2.29; 95% CI:
1.12, 4.68; p = 0.023) by follow-up.
Medications
Emotional (depression)
Alcoholism,anorexia tardive, abuse (elder)
Late life paranoia
Swallowing problems
Oral problems
Nosocomial infections,no money (poverty)
Wandering/dementia
Hyperthyroidism,hypercalcemia,hypoadrenalism
Enteric problems (malabsorption)
Eating problems (eg. Tremor)
Low salt, low cholesterol diet
Shopping and meal preparation problems, Stones (cholecystitis)
Causes of Weight Loss
Morley JE, Silver AJ. Ann Intern Med 1995;123:850-859.
Families and physicians fail to recognize
dementia.
Mini-Mental Status ExaminationFolstein et al. 1975
1. Educationally dependent
2. Both false positives and false negatives
3. Minimal testing of visuospatial system
ROCs For SLUMS &MMSE for MCI > HS
Education
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
1-Specificity
Sen
sitiv
ity
Area Under Curve = 94.1%
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
1-Specificity
Sen
siti
vit
y
Area Under Curve = 64.3%
SLUMS MMSE
Am J Geriatr Psychiatry. 2006;14:900-910.
Rapid Cognitive Screen (RCS) - Dementia
DementiaScores ≤ 5 Sen=0.89,
Spc=0.94
AUC (95% CI)
RCS 0.98 (0.95-1.00)
Mini-Cog 0.92 (0.89-0.95)
Rapid Cognitive Screen and MCI(5 words, clock, story with country)
RCS vs MiniCogRCS
2.5 minutes to complete
MCI and Diabetes
Reversible Causes of MCI
D
E
M
E
N
T
I
A
rugs (digoxin, theophylline, cimetidine, anticholinergic
motional (depression)
etabolic (hypothyroidism)
yes and ears (sensory isolation)
ormal Pressure Hydrocephalus (ataxia, incontinence, and dementia)
umor or other space-occupying lesion
nfection (syphilis, chronic infections)
nemia (vitamin B12 deficiency)/Alcoholism
S leep Apnea
Mediterranean Diet associated with
reduced risk of Alzheimer’s Disease
Exercise and the Brain
Aerobic exercise for 6 months decreased
brain atrophy…..
Colcombe et al
J Gerontol A 2006; 61:1166
Increased cognition
Decreased dysphoria
LIFE Study suggests needFor HIGH DOSE exercise
Tiia Ngandu , Jenni Lehtisalo , Alina Solomon , Esko Levälahti , Satu Ahtiluoto , Riitta Antikainen , Lars Bäckma...
A 2 year multidomain intervention of diet, exercise, cognitive training, and
vascular risk monitoring versus control to prevent cognitive decline in at-risk
elderly people (FINGER): a randomised controlled trial
Aged 60-77 years recruited from previous national
surveys.
A 2 year multidomain intervention (diet, exercise,
cognitive training, vascular risk monitoring), or a
control group (general health advice).
1260 to the intervention group (n=631) or control
group (n=629).
FINGER STUDY
Management of Cognitive Dysfunction
Exclude Treatable Causes
• Anticholinergic drugs
• Depression
• Hypothyroid (TSH)
• Vitamin B12 deficiency
• Hearing and visual problems
• Atrial fibrillation
• Sleep Apnea
Lifestyle
• Mediterranean diet
• Olive oil
• Exercise
• Computer games
• Socialisation
• Cognition Stimulation Therapy
• Refer to Alzheimers Association
• Safe return bracelet
• Discuss driving/guns
Cognitive Stimulation Therapy : NHC Nursing Home
Cardinals Reminiscence League
0.0%
20.0%
40.0%
60.0%
80.0%
Screening Case Finding Nursing Homes PACE
Normal Cognition 54.4% 55.2% 15.0% 51.1%
MCI 21.8% 19.9% 14.8% 17.8%
Dementia 23.8% 24.8% 70.2% 31.1%
% o
f To
tal
RCSJuly 1, 2015 - December 31, 2016
Jean Woo , Ruby Yu , Moses Wong , Fannie Yeung , Martin Wong , Christopher Lum
Frailty Screening in the Community Using the FRAIL Scale
Elderly Centers in the New Territories East Region of Hong Kong SAR China.
Information Sheets are Available
for Older Persons who Screen Positive
for Frailty, Sarcopenia or Cognitive
Dysfunction
Frailty
Information Sheet
Your screening test indicates you may be experiencing frailty. Physical frailty is an important medical syndrome. It is defined as diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability to developing increased dependency or death.
It can be prevented or treated with aerobic and resistance exercise, protein-calorie supplementation, vitamin D, and a reduction of polypharmacy. To do this, please consider trying a few of the below exercises:
• Sit up from a chair five times• Use 5 lb weights to exercise your arms• Do aerobic workouts, such as 20 minutes of walking per day• Try standing on one foot while holding onto something and closing your eyes
Please see your physician for monitoring and treatment of your condition.
RCS Score _____/10
AD8 Score _____/8
Brain Health
Information Sheet
Your screening test shows you may be experiencing some mild cognitive impairment. While some forgetfulness is normal with age, there are some concerning signs, as well as a few reversible causes, and some treatments that may help conserve your mental status.
Early recognition of cognitive impairment can help doctors, caregivers, and family members in managing comorbid conditions and anticipating problems. While there may be pharmacological interventions for specific reversible causes of dementia, there are also some lifestyle adaptions that can help. Some changes along these lines are listed here:• Do brain games, such as crosswords or those available on computers• Eat plenty of fruits, vegetables, and whole grains. The Mediterranean diet might be a good place to start. Increasing
your intake of extra virgin olive oil is particularly helpful• Have your doctor check for treatable conditions• Stay active! Find a physical activity you like, whether it is walking, hiking, swimming, or something new. Try to do it for a
half hour, five times a week.• Be involved socially in the community, such as going on walks or to lunch with friends, doing volunteer work, or trying a
new hobby.
Please talk with your physician about possible causes, questions, and for monitoring your condition. There are a number of treatable causes of memory problems including depression, sleep apnea, hypothyroidism and vitamin B12 deficiency.
SARC-F Score ______/10
Sarcopenia Information Sheet
Your screening test has indicated you might have sarcopenia. Sarcopenia is a loss of skeletal muscle mass and function over time, and is correlated with physical disability, poor quality of life, and death. While it can sometimes cause weight loss, reduced muscle may be replaced by fat mass so that overall weight might not change. There are ways to stop sarcopenia in its tracks, and they focus mostly on exercise and nutrition interventions.
Here is a list of workouts that can be done to reduce and reverse sarcopenia. Resistance training exercises are especially important, either against body weight or with small weights.
• Sit up from a chair five times• Use 5 lb weights to exercise your arms• Do aerobic workouts, such as 20 minutes of walking per day• Try standing on one foot while holding onto something and closing your eyes• Take a high whey protein supplement once daily• Take 1000IU of vitamin D daily• Eat one yogurt at night before going to bed
Please consult your physician if you have any questions and for monitoring your condition.
Medicare Plans to Pay Doctors for Counseling on End of Life
Historic Human Mortality Rates
Do specific programs enhance outcomes?
Conclusion
• Rapid Geriatric Assessment can be completed within 4
minutes and used as major component of Medicare
Wellness Examination
• Simple guide to treatment and patient handouts available
• Medicare to pay for end of life discussion
Sulfonylureas and Insulin increase mortality in
diabetics; metformin doesn’t
Diabetics with autonomic neuropathy are at
increased risk for sudden death. Need an
implantable loop recorder?
Sleep apnea causes hypertension, hyperglycemia
and cognitive dysfunction
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All Materials Available for RGA
Aging.slu.edu