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10-Minute Geriatric Screener Tool

This document provides a 10 minute geriatric screener developed by Dr. Henry S. Villarosa Jr. of the Appleone Brokenshire Medical Corporation. The screener evaluates 11 areas that are important to assess for older patients: vision, hearing, leg mobility, urinary incontinence, nutrition/weight loss, memory, depression, and physical disability. For each area, it lists brief screening measures and response options to document the patient's abilities and difficulties. The screener is designed to be attached to the patient's medical chart after administration to formally record the results.

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2K views2 pages

10-Minute Geriatric Screener Tool

This document provides a 10 minute geriatric screener developed by Dr. Henry S. Villarosa Jr. of the Appleone Brokenshire Medical Corporation. The screener evaluates 11 areas that are important to assess for older patients: vision, hearing, leg mobility, urinary incontinence, nutrition/weight loss, memory, depression, and physical disability. For each area, it lists brief screening measures and response options to document the patient's abilities and difficulties. The screener is designed to be attached to the patient's medical chart after administration to formally record the results.

Uploaded by

taiso
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

APPLEONE BROKENSHIRE MEDICAL CORPORATION

DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE


PREPARED BY: DR. HENRY S. VILLAROSA, JR.

10 MINUTE GERIATRIC SCREENER


Problem Screening Measure Response
VISION 2 Parts: Ask: “Do you have difficulty driving, or watching ____ Yes
television, or reading, or doing any of your daily activities ____ No
because of your eyesight?”

If yes, then: Test each eye with Snellen chart while patient
____ able to read greater than 20/40 on
wears corrective lenses (if applicable).
Snellen chart
____ inability to read greater than 20/40 on
Snellen chart

Hearing Use audioscope set at 40 dB. Test hearing using 1,000 and ____ able to hear 1,000 or
2,000 Hz. 2,000 Hz in both ears
or either of these
frequencies in one ear
____ inability to hear 1,000 or
2,000 Hz in both ears
or either of these
frequencies in one ear
Leg mobility Time the patient after asking: ____ able to complete task
“Rise from the chair. Walk 20 feet briskly, turn, walk in 15 seconds
back to the chair ____ unable to complete task
and sit down.” in 15 seconds
Urinary 2 Parts:
incontinence Ask: “In the last year, have you ever lost your urine and
____ Yes
gotten wet?”
____ No

If yes, then ask:


“Have you lost urine on at least 6 separate dates?”
____ Yes
____ No
Nutrition/ 2 Parts:
weight loss Ask: “Have you lost 10 lbs over the past 6 months without
____ Yes
trying to do
____ No
so?”

Weigh the patient.


____ weight >/=100 lbs
____ weight <100 lbs
Memory Three-item recall ____ able to remember
all three items after
1 minute.

____ unable to remember


all three items after
1 minute.
Depression Ask: “Do you often feel sad or depressed?” ____ Yes
____ No
Physical Six questions:
disability “Are you able to . . . :
“Do strenuous activities like fast walking or bicycling?”
____ Yes
____ No
“Do heavy work around the house like washing windows,
____ Yes
walls, or
____ No
floors?”
“Go shopping for groceries or clothes?”
____ Yes
____ No
“Get to places out of walking distance?”
____ Yes
____ No
“Bathe, either a sponge bath, tub bath, or shower?” ____ Yes
____ No
____ Yes
“Dress, like putting on a shirt, buttoning and zipping, or
____ No
putting on
shoes?”

PLEASE ATTACH THIS PAPER TO THE CHART.


SOURCE: BATES’ GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING
APPLEONE BROKENSHIRE MEDICAL CORPORATION
DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
PREPARED BY: DR. HENRY S. VILLAROSA, JR.

____ No to any of the questions above.

PLEASE ATTACH THIS PAPER TO THE CHART.


SOURCE: BATES’ GUIDE TO PHYSICAL EXAMINATION AND HISTORY TAKING

APPLEONE BROKENSHIRE MEDICAL CORPORATION DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE PREPARED BY: DR. HENRY S. VILLAROSA, JR.
APPLEONE BROKENSHIRE MEDICAL CORPORATION DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE PREPARED BY: DR. HENRY S. VILLAROSA, JR.

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