Ethnicity and Geriatric Assessment
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Gallo_FM_i-xviii 8/1/05 5:23 PM Page i HANDBOOK OF GERIATRIC ASSESSMENT Fourth Edition Edited by Joseph J. Gallo, MD, MPH Associate Professor Department of Family Practice and Community Medicine Department of Psychiatry University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Hillary R. Bogner, MD, MSCE Assistant Professor Department of Family Practice and Community Medicine University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Terry Fulmer, PhD, RN, FAAN The Erline Perkins McGriff Professor & Head, Division of Nursing New York University New York, New York Gregory J. Paveza, MSW, PhD Interim Associate Vice President for Academic Affairs University of South Florida – Lakeland Lakeland, Florida Gallo_FM_i-xviii 8/1/05 5:23 PM Page ii World Headquarters Jones and Bartlett Publishers 40 Tall Pine Drive Sudbury, MA 01776 978-443-5000 [email protected] www.jbpub.com Jones and Bartlett Publishers Canada 6339 Ormindale Way Mississauga, ON L5V 1J2 CANADA Jones and Bartlett Publishers International Barb House, Barb Mews London W6 7PA UK Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website at www.jbpub.com. Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to [email protected]. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. Copyright © 2006 by Jones and Bartlett Publishers, Inc. Library of Congress Cataloging-in-Publication Data Handbook of geriatric assessment / edited by Joseph J. Gallo ... [et al.].— 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 0-7637-3056-4 (case bound) 1. Older people—Diseases—Diagnosis—Handbooks, manuals, etc. 2. Older people—Psychological testing—Handbooks, manuals, etc. 3. Older people—Care— United States—Handbooks, manuals, etc. [DNLM: 1. Geriatric Assessment. WT 30 H2374 2006] I. Gallo, Joseph J. RC953.G34 2006 618.97Ј075—dc22 9637 005008303 Production Credits Acquisitions Editor: Kevin Sullivan Associate Editor: Amy Sibley Production Director: Amy Rose Production Assistant: Kate Hennessy Marketing Manager: Emily Ekle Manufacturing Buyer: Amy Bacus Composition: Graphic World Cover Design: Anne Spencer Printing and Binding: Malloy, Inc. Cover Printing: Malloy, Inc. Printed in the United States of America 0908070605 10987654321 Gallo_FM_i-xviii 8/1/05 5:23 PM Page iii Contents Contributors . .ix Preface . .xv Section I: The Context of Assessment . .1 Chapter 1—The Context of Geriatric Care . .3 Joseph Gallo, Hillary R. Bogner The Context of Geriatric Care . .3 Multidimensional Assessment . .6 Conclusion . .11 Chapter 2—Emergency Assessment of the Older Adult . .15 Chad VanDerHeyden, Arthur Sanders Emergency Care . .15 Prehospital EMS System . .17 ED Environment . .19 Emergency Medicine Model of Care . .20 Principles of Geriatric Emergency Medicine . .22 Summary . .26 iii Gallo_FM_i-xviii 8/1/05 5:23 PM Page iv iv HANDBOOK OF GERIATRIC ASSESSMENT Chapter 3—Ethnicity and Geriatric Assessment . .29 Charles P. Mouton, Yolanda B. Esparza Heterogeneity Within Older Ethnic Minorities . .30 Reliability, Validity, and Use of Instruments for Ethnic Minorities . .31 Enhancing Communication With Ethnically Diverse Older Adults . .33 Eliciting Beliefs and Attitudes About Illness . .34 Selected Domains of Geriatric Assessment . .35 Conclusion . .39 Chapter 4—The Older Adult Driver . .45 David Carr, George W. Rebok Older Drivers . .45 Behaviors and Characteristics of Older Drivers . .46 Older Drivers at Risk for a Motor Vehicle Crash . .48 Driving Retirement . .51 Assessing Driving Skills . .52 Ethical, Legal, and Public Policy Issues . .54 Future Research Needs and Conclusions . .54 Chapter 5—Enhancing Advance Directive Discussions Using the Values History . .59 David J. Doukas, Laurence B. McCullough, Monica K. Crane The Living Will . .60 The DPA/HC . .61 The Family Covenant . .62 The Values History . .63 Case Vignette . .66 Conclusion . .68 Appendix A—The Values History . .70 Chapter 6—Recognizing Mistreatment in Older Adults . .77 Carla VandeWeerd, Adolfo Firpo, Terry Fulmer, Gregory J. Paveza, Marguarette M. Bolton The Scope and Consequences of EM . .78 EM Assessment . .78 Physical Abuse Assessment . .80 Sexual Abuse Assessment . .83 Psychological Mistreatment Assessment . .86 Neglect Assessment . .88 Financial Abuse Assessment . .91 Gallo_FM_i-xviii 8/1/05 5:23 PM Page v Contents v Screening Tools . .93 Conclusion . .97 Section II: Domains of Assessment . .103 Chapter 7—Cognitive Assessment . .105 Joseph J. Gallo, Marsha N. Wittink The Mental Status Examination . .107 Differential Diagnosis of Dementia . .118 Mental Status Assessment Instruments . .127 Summary of Mental Status Assessment . .143 Chapter 8—Depression Assessment . .153 Joseph J. Gallo, Marsha N. Wittink Depression Scales . .158 Chapter 9—Substance Use and Abuse Assessment . .175 Faika Zanjani, David Oslin Classification . .177 Alcohol Consumption . .178 Drug Use . .181 Tobacco Use . .185 Barriers to the Use of Substance Use Assessments . .185 Conclusions/Recommendations . .187 Appendix—MAST-G . .191 Appendix—SMAST-G . .192 Chapter 10—Activities of Daily Living and Instrumental Activities of Daily Living Assessment . .193 Joseph J. Gallo, Gregory J. Paveza Focus on Function . .193 The Components of Functional Status . .197 Performance Assessment of Function . .208 Case Study: Assessment of ADLs . .214 Dementia Rating Scales . .216 Assessment for Long-Term Care . .230 Case Study: Assessment for Long-Term Care . .232 Conclusion . .234 Chapter 11—Social Assessment . .241 Carmen Morano, Barbara Morano Assessment of Social Support . .242 Gallo_FM_i-xviii 8/1/05 5:23 PM Page vi vi HANDBOOK OF GERIATRIC ASSESSMENT Assessment of Caregiver Burden and Satisfaction . .248 Assessment of Older Person Mistreatment . .252 Economic Assessment . .255 Medicare . .258 Medicaid . .258 Private Health Insurance . .259 Long-Term Care Insurance . .259 Assessment of the Environment . .260 Spiritual Assessment . .261 Chapter 12—Physical Assessment . .273 David Nicklin Communication and Rapport . .274 Examination of Older Adults with Dementia . .276 History Taking . .277 Overview of the Physical Examination . .279 Components of the Examination . .279 Sexual Health Assessment . .304 Conclusion . .311 Chapter 13—Pain Assessment . .319 James P. Richardson Case Vignette . .319 Historical Assessment of Pain . .321 Physical Assessment of Pain . .324 Pain Assessment in Cognitively Impaired Older Adults . .328 Conclusion . .328 Chapter 14—Health Promotion . .331 Meredith Wallace, Joyce Shea, Carrie Guttman.