Pathy's Principles and Practice of Geriatric Medicine. Группа авторов

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* * * * Consider Cognitive screening Do initially; do if symptomatic^a Do initially; do if symptomatic Do initially Consider if symptomatic Depression screening Do initially; do if symptomatic Do initially; do if symptomatic Do initially; do if symptomatic Do initially; do if symptomatic Screening for gait and balance Do initially; do if symptomatic Do initially; do if symptomatic Do initially; do if symptomatic Do if symptomatic Advance directives Do yearly and as needed Do yearly and as needed Do yearly and as needed Do yearly and as needed Influenza vaccine Do yearly Do yearly Do yearly Do yearly Pneumococcal vaccine Do once; consider repeat every 6 years for patients with chronic diseases Do once Do once Consider vaccination once Tetanus Do primary series if not vaccinated before and booster every 10 years Do primary series if not vaccinated before Do primary series if not vaccinated before * * * * Zostavax Hepatitis C Do once Do once Do once Do once Do once * * * * Consider * * * * Breast examination Do yearly Do yearly Do yearly * * * * Mammography Do every 1–2 years up to age 80 Consider every 1–2 years up to age 75 Consider every 1–2 years up to age 70 * * * * Pap smear Consider 1–3 Pap smears if patient has never had one * * * * * * * * * * * * Faecal occult blood test Do yearly Consider yearly Consider yearly * * * * Colonoscopy Consider every 10 years * * * * * * * * * * * * PSA Discuss pros and cons with patient Discuss pros and cons with patient Discuss pros and cons with caregiver * * * * Osteoporosis Do at least once; consider every 2 years Do at least once every 2 years Do at least once * * * * Cholesterol screening Consider screening for patients aged 65–75 if they have additional risk factors (e.g. smoking, diabetes, hypertension) Consider screening for patients aged 65–75 if they have additional risk factors (e.g. smoking, diabetes, hypertension) * * * * * * * * TSH Do every 5 years or if symptomatic Do every 5 years or if symptomatic Do every 5 years or if symptomatic Consider Fasting blood glucose Do if symptomatic or every 3 years if the patient has risk factors Do if symptomatic or every 3 years if the patient has risk factors Do if symptomatic or every 3 years if the patient has risk factors Consider if symptomatic Sleep apnoea Abdominal aortic aneurism Do yearly Do once Do yearly Do once * * * * * * * * * * * * * * * *

      MNA, Mini‐Nutritional Assessment; OTC, over‐the‐counter; ADLs, activities of daily living; IADLs, instrumental activities of daily living; ADAM, androgen deficiency in adult males; PSA, prostate‐specific antigen; SNAQ, Simplified Nutritional Assessment Questionnaire; TSH, thyroid‐stimulating hormone.

      ^a The term symptomatic refers to any complaint given by the patient or caregiver or any problem observed/elicited by the clinician.

      Since screening for weight loss is very low‐cost and low‐risk and the benefits of intervention are somewhat positive, it should be done for patients in all categories except End of Life. Outpatient screening of unintentional weight loss of 10% or greater in one year is indicative of significant malnutrition.

      Using validated screening tools such as the Simplified Nutritional Appetite Questionnaire (SNAQ) or Mini‐Nutritional Assessment (MNA) can identify patients who are malnourished or at risk for malnutrition.⁸

      Height

      Since measuring height is a low‐cost screening intervention – and as bone loss occurs, height may decrease – it may be an effective and economical method to identify early osteoporosis of the spine for Robust and Frail elderly. One study showed a significant association with historical height loss of 1.5 cm and vertebral fractures.⁹

      Pain

      Pain should now be considered the fifth vital sign and should be assessed at every visit for patients in all categories. Use of Likert scales (e.g. 1–10) or a pictorial scale (e.g. facial expressions) can be useful to quantify pain. Even patients with dementia can be evaluated for pain, using such tools as the CNA Pain Assessment Tool (CPAT) and the Pain Assessment in Advanced Dementia Scale (PAINAD‐G).^10,11

      Medication review including over‐the‐counter (OTC) and herbal medicines

      The risk of adverse drug events, poor compliance, and drug–drug interactions, and even the risk of hospitalization, are most associated with the

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