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    Rapid Geriatric Assessment

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    taiso

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    © All Rights Reserved
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    Rapid Geriatric Assessment

    Uploaded by

    taiso
    90 views1 page

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    rapid-geriatric-assessment

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    90 views1 page

    Rapid Geriatric Assessment

    Uploaded by

    taiso

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    © All Rights Reserved
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    of 1

    Saint Louis University

    Rapid Geriatric Assessment*


    *There is no copyright on these screening tools and they may be
    incorporated into the Electronic Health Record without permission and at
    no cost.

    ID#: Sex: Age: Primary Care Provider Y / N


    Ethnicity (circle): African/Am Asian Caucasian Hispanic Non-Hispanic

    The Simple “FRAIL” Questionnaire SARC-F Screen for Sarcopenia


    Screening Tool (Loss of Muscle)
    Component Question
    Fatigue: Are you fatigued? Strength How much difficulty do you have in
    Resistance: Cannot walk up one flight of lifting and carrying 10 pounds?
    stairs? Scoring: None = 0 Some = 1 A lot or unable = 2
    Aerobic: Cannot walk one block? Assistance in How much difficulty do you have
    Illnesses: Do you have more than 5 Walking walking across a room?
    illnesses? Scoring: None = 0 Some = 1 A lot , use aids or unable = 2
    Loss of weight: Have you lost more than Rise from a How much difficulty do you have
    5% of your weight in the last 6 months? Chair transferring from a chair or bed?
    Scoring: None = 0 Some = 1 A lot or unable without
    help = 2

    Scoring: 3 or greater = frailty; 1 or 2 = prefrail Climb stairs How much difficulty do you have
    climbing a flight of ten stairs?
    _____ Scoring: None = 0 Some = 1 A lot or unable = 2
    From Morley JE, Vellas B, Abellan van Kan G, et al.
    J Am Med Dir Assoc 2013;14:392-397. Falls How many times have you
    fallen in the last year?
    Scoring: None = 0 1-3 Falls = 1 4 or more falls = 2
    5PUBM'3"*-4DPSF@@@@@@@@@@@ Total score of 4 or more indicates Sarcopenia

    From Malmstrom TK, Morley JE. J Frailty and Aging2013;2:55-6.


    5PUBM4"3$'4DPSF@@@@@@@@@@

    SNAQ (Simplified Nutritional Assessment Rapid Cognitive Screen (RCS)


    Questionnaire) 1. Please remember these five objects. I will ask you what
    they are later.
    My appetite is Food tastes [Read each object to patient using approx. 1 second intervals.]
    a. very poor a. very bad Apple Pen Tie House Car
    b. poor b. bad
    c. average c. average 2. [Give patient pencil and the blank sheet with clock face.] This
    d. good d. good is a clock face. Please put in the hour markers and the
    e. very good e. very good time at ten minutes to eleven o’clock
    . [2 pts/hr markers ok; 2 pts/time correct]
    When I eat Normally I eat
    a. I feel full after eating a. Less than one meal a 3. What were the five objects I asked you to remember?
    only a few mouthfuls day [1 pt/ea]

    b. I feel full after eating b. One meal a day 4. I’m going to tell you a story. Please listen carefully
    about a third of a meal because afterwards, I’m going to ask you about it.
    c. I feel full after eating c. Two meals a day
    over half a meal 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
    d. I feel full after eating d. Three meals a day married him and had three children. They lived in Chicago. She then
    most of the meal 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
    e. I hardly ever feel full e. More than three meals ever after.
    a day What state did she live in? [1 pt]
    SCORING
    Scoring: a=1, b=2, c=3, d=4, e=5.
    8-10……... Normal
    A score <14 indicates significant risk of at least 5%
    6-7………. Mild Cognitive Impairment
    weight loss within 6 months. Dementia
    0-5……….
    From Wilson et al. Am J Clin Nutr 2005;82:1074-81.
    From Malmstrom TK, Voss VB, Cruz-Oliver DM et al J Nutr Health
    Aging 2015;19:741-744.
    5PUBM4/"24DPSF@@@@@@@@@@
    5PUBM3$44DPSF@@@@@@@@@@

    Advance Directive
    Do you have an advance directive? Y/N
    3FWJTFE

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