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physician evaluation at nursing home admission
History:
1) reason(s) for seeking admission
2) status of active medical problems
3) functional status
a) basic activities of daily living (bADL)
b) instrumental activities of daily living (iADL)
3) past medical history
a) chronic medical conditions
b) surgical procedures
4) preventative care
a) vaccinations
b) dental care
c) optometry
d) podiatry
5) medications
6) review of systems
Physical examination:
1) traditional physical examination
2) additional components
a) orthostatic changes in blood pressure
b) nutritional status
c) screening for hearing problems
-> audiometry may be helpful
d) visual capabilities
e) mobility
1] direct observation of the ability to walk or transfer
2] Tinetti balance & gait testing may be useful
f) cognitive function
-> standardized cognitive assessment may be useful (Folstein mini mental status examination (MMSE))
g) affective status
-> standardized testing may be useful (geriatric depression scale (GDS))
Notes:
Functional status
1) basic activities of daily living
2) instrumental activities of daily living
Socioeconomic status
1) nature of family relationships
2) relevant financial information
a) private pay
b) Medicaid
c) Medicare
Advance directives
1) designation of proxy decision maker
2) intensity of care desired
Related
activities of daily living (ADL)
annual physician review of long term nursing home residents
Folstein Mini-Mental Status Examination (MMSE)
geriatric depression scale (GDS)
medical progress notes on nursing home residents
minimum data set (MDS) for nursing home residents
Tinetti gait & balance evaluation
References
- Ouslander JG, Osterweil D.
Physician evaluation and management of nursing home residents.
Ann Intern Med 120:584, 1994
PMID: 8116998