الفهرس 
INTRODUCTION AND RATIONALOnly 14 pages are availabe for public view
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Abstract
Approximately one-half of the ambulatory primary care for adults older than 65 years is provided by family physicians, and approximately 22 percent of visits to family physicians are from older adults. 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.
A complete assessment is usually initiated when the physician detects a potential problem such as confusion, falls, immobility, or incontinence. However, older persons often do not present in a typical manner, and atypical responses to illness are common. A patient presenting with confusion may not have a neurologic problem, but rather an infection. 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. Thus, a more structured approach to assessment can be helpful.
The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person’s functional ability, physical health, cognition and mental health, and socio-environmental circumstances. It includes an extensive review of prescription and over-the-counter drugs, vitamins, and herbal products, as well as a review of immunization status. This 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.
The geriatric assessment differs from a typical medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of life; and, often, by incorporating a multidisciplinary team including a physician, nutritionist, social worker, and physical and occupational therapists. This type of assessment often yields a more complete and relevant list of medical problems, functional problems, and psychosocial issues.
Because of the demands of a busy clinical practice, most geriatric assessments tend to be less comprehensive and more problem-directed. For older patients with many concerns, the use of a “rolling” assessment over several visits should be considered. The rolling assessment targets at least one domain for screening during each office visit. Patient-driven assessment instruments are also popular. Having patients complete questionnaires and perform specific tasks not only saves time, but also provides useful insight into their motivation and cognitive ability.