chronic conditions; self-reported health status; functional sta-tus (e.g., upper/lower body limitations, activities of daily living (ADL) limitations); and geriatric syndromes (e.g., de-pressive symptoms, and incontinence). Geriatric syndromes include a number of ... Delirium is a geriatric syndrome that should be considered with any change in mental status and cognition. kati_hughes. University of Virginia Health System . *This test shows a strong correlation btw functional independence and ability to do ADL's. JAMA 273:1348-1353, 1995) Examples: – Delirium – Falls – Urinary incontinence – Frailty – Functional decline . A symptom, or a complex of symptoms, resulting from multiple diseases and risk factors, "SPICES" Framework (Fulmer) for assessing for Geriatric Syndromes, - A ratio of the amount of time spent sleeping compared to the amount of time spent in bed (time sleeping / time in bed), - A self-rated questionnaire that assesses sleep quality and disturbances over 1-month, Sleep Disturbance - Nursing Interventions, - Avoid chemicals, especially ETOH & caffeine before bed, Problems with Eating & Feeding - Nursing Interventions, Problem: patient is confused, not oriented, has loss of memory, Evidence of Falls - Nursing Interventions, - Assessing, documenting, & advocating for pain relief, Components Affecting Geriatric Syndrome(s), Illness caused by medical examination or treatment, common in hospitalized older adults with complex illnesses and longer lengths of stay, Spiraling, unintended decline of health, caused by medical treatments and interventions. Involuntary loss of urine associated with over distention and overflow of the bladder. Since aging is a normal and fundamental part of life. Digital Clinical Experiences are powered by our Conversation Engine and assessed using our proprietary Student Performance Index. Elderly may be btw 11-20. Should be 10 secs for a healthy adult. E valuating functional status and geriatric syndromes are critical to the health assessment of older adults and are often used to help predict their subsequent health outcomes. Indicates an item that is available to be found. - Created and mandated for use by certified home care agencies. Functional status assessment is fundamental to geriatric care. They usually have more than one cause and involve many parts of the body. Young old 65 to 74 years Middle old 75 to 84 years Old-old 85 years and older. Log in Sign up. Americans are living longer and healthier lives. 3/20/2019 Focused Exam: End of Life | Completed | Shadow Health 1/7 Indicates an item that you found. Involuntary leakage of urine with a sudden, strong desire to urinate. What is a geriatric syndrome? Instrumental activities of daily living (those needed for independent living). The hallmarks of delirium are acute onset, fluctuating course, impaired attention, and cognitive changes. Learn vocabulary, terms, and more with flashcards, games, and other study tools. When urine leaks during exercise and certain movements that cause pressure on the bladder. - Especially useful in documenting improvement in a patient's ability, especially those who have suffered strokes. Test to see hoe long it takes to get out of chair, walk 10 feet, turn, return to chair and sit. - Used to identify cognitive impairment & measure severity but does not establish criteria for dementia. Geriatrics healthcare professionals can play an important role in managing these syndromes. Geriatric Syndromes. Functional disability is common in older adults. - Used to assess both functional status and cognitive abilities, Mental Status / Cognitive Ability Assessments. Both subjective and objective evaluations of geriatric functional measures (GFM) and geriatric syndromes (GS) exist. What is the significance of geriatric syndromes? Please share how this access benefits you. Capacity to function is poorly indicated by dx alone. This may seem a startling claim, but on reflection it is uncontroversial. “Multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render a person vulnerable to situational challenges” (Tinetti et al. The Geriatric Resources for Assessment and Care of Elders (GRACE) model of primary care for low-income seniors and their primary care physicians (PCPs) was developed to improve the quality of geriatric care so as to optimize health and functional status, decrease excess healthcare use, and prevent long-term nursing home placement. A geriatric assessment includes an evaluation of an older individual’s functional status, medical conditions (comorbidities), cognition, nutritional status, psychological state, and social support, as well as a review of the patient’s medications (Table 4-1). Questions focus on the related challenges facing the nursing professional caring for the geriatric patient population. - A 30-point tool used to screen for cognitive difficulties. What is needed for individuals to be able to stay home? Geriatric Assessment. Log in Sign up. Widely known and studied that functional status is most important predictor of mortality. Geriatric assessment uses specific tools to help determine patient's status across several different dimensions, including assessment of medical, cognitive, affective, social, economic, environmental, spiritual, and functional status. What is a geriatric syndrome? Goal of interventions is to enable elders to function at highest level despite the presence of age related changes, risk factors, and disease. A change in functional status is often the only or the first sign of illness or exacerbation of a chronic condition. It is comprised of 3 parts: Outcomes & Assessment Information Set (OASIS & OASIS-C). What geriatric syndrome often come with coronary artery disease, heart failure, and diabetes? Create . - Ranks functional status as either independent or dependent - Provides further classification of independent into "intact" or "limited" and dependent into "needing a helper" or "unable to do the activity at all." Functional status Fig 1. Geriatric Depression Scale. Overview With the aging of the population, more frail patients are being seen by their primary care physicians. RNs to identify factors that cause negative consequences and initiate interventions leading to positive functional consequences. "Common clinical problems among the elderly" Stress Incontinence. Assessing Functional Status and Qualify of Life in Older Adults Cathy Alessi, MD Geriatric Research, Education and Clinical Center; VA Greater Los Angeles . Frailty is more often seen in patients 75 and older who have cognitive or physical impairments that interfere with the performance of their activities of daily living. what are the major geriatric syndromes. In regard to evidence-based prevention of long-term care dependence, various geriatric syndromes, such as undernutrition, falling, incontinence and decline of cognitive function, are the major targets for prevention. What are the two most critical factors of IADLs. As we age, we are more likely to develop health problems called geriatric syndromes. Interacting dimensions of geriatric assessment. Patients . 1 According to a literature review, the five conditions most commonly considered geriatric syndromes are pres-sure ulcers, incontinence, falls, functional decline, and delirium. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. David Geffen School of Medicine at UCLA . Functional ability correlates with mortality. Search. The ASA Physical Status Classification System has been in use for over 60 years. 1 According to a literature review, the five conditions most commonly considered geriatric syndromes are pres-sure ulcers, incontinence, falls, functional decline, and delirium. What is the presence of geriatric syndromes significantly associated with? Geriatric Syndrome. which complements a cognitive assessment including screening for dementia. Shadow Health's Digital Clinical Experiences allow nursing students to demonstrate and perfect their clinical reasoning skills through life-like interactions with Digital Standardized Patients. For each of the dimension Clinically defined by the presence of 3 or more of the following criteria: The 3 Methods of Collecting Assessment Data. 135 terms. which complements a cognitive assessment including screening for dementia. Geriatric wisdom holds that age is a good predictor of average change but not of individual change because health status varies increasingly with age. Americans are living longer and healthier lives. View Lab Report - Focused Exam Infection Subjective_ Shadow Health.pdf from NURS 201 at West Coast University. GERIATRIC SIMULATIONS TOOLKIT This toolkit is a resource for nurse educators wishing to advance the preparation of nurses to care for older adults across a variety of settings, including the hospital, the home, and skilled nursing facilities. Occurs with person(s) who have experienced a deterioration of physical capacities due to advanced age and must rely on mechanical assistance or the assistance of others. Geriatric syndromes appear to be better predictors of death than the presence or number of specific diseases. Geriatricians have embraced the term “geriatric syndrome,” using it extensively to highlight the unique features of common health conditions in older people. Comparison between traditional medical syndromes and geriatric It can be mistaken for dementia, depression, or another psychiatric problem. What does functional ability correlate with? “Multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render a person vulnerable to situational challenges” (Tinetti et al. Patient Data Not Scored A combination of open and closed questions will yield better patient data. Function, the ability to manage daily routines, can not be well-correlated with medical diagnoses or length of the problem list. - A classic measure of levels of cognitive changes as one passes through the process of dementia. Geriatrics healthcare professionals can play an important role in managing these syndromes. Digital Clinical Experiences . skin impairment, poor nutrition, falls or functional decline, incontinence , cognitive impairment, skin impairment, and sleep disturbances. The Shadow Health Experience. The purpose of this article will be to review the specific tools that practitioners can use in their screening for geriatric syndromes when evaluating patients. Indicates an item that is available to be found. - Measures IADLs, which are more complex than ADLs and require greater physical and cognitive functioning. These measures may be used individually or collectively in indices. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. She is having problems with incontinence and is wearing incontinence pads. health status of frail, older patients. Hover over the Patient Data JAMA 273:1348-1353, 1995) Examples: – Delirium – Falls – Urinary incontinence – Frailty – Functional decline . They usually have more than one cause and involve many parts of the body. All illness has both psychological and physical dimensions. The Lawton Instrumental Activities of Daily Living Scale (IADL) is an instrument developed to assess independent living skills (Lawton & Brody, 1969). Functional status Fig 1. Geriatric Syndromes Clusters of age-related changes, medical conditions, symptoms, and medication effects that are associated with functional decline and adverse health outcomes conditions in older persons that do not fit into discrete disease categories contribute to geriatric syndromes. On the other hand, the client’s cognitive and functional status and values must often be taken into account before deciding how aggres-sively medical problems should be approached. The catalyst for the GRACE intervention is the GRACE … The simulation occurs in the ED. This theoretical point has practical implications. decline in physical function that increases fragility and susceptibility to acute and chronic health problems. Subjective Data Collection: 0 of 53 (0.0%) Hover To Reveal. The purpose of this article will be to review the specific tools that practitioners can use in their screening for geriatric syndromes when evaluating patients. Besides leading to increased mor-tality and disability, decreased financial and personal resources, and longer hospitalizations, these conditions can substantially diminish quality of life. The Katz Index of Activities of Daily Living (Katz ADL) is designed to assess functional status, specifically, the client's ability to perform activities of daily living (ADLs) independently. Geriatric assessment provides an overview of the general health status of older individuals and determines the functional and physiological age, which is more important than chronological age. STUDY. health status. contribute to geriatric syndromes. What do geriatric syndrome often co-occur with? Patricia Young, 74, comes to the ED with a UTI and confusion from the infection. Besides leading to increased mor-tality and disability, decreased financial and personal resources, and longer hospitalizations, these conditions can substantially diminish quality of life. View Lab Report - Focused Exam Infection Subjective_ Shadow Health.pdf from NURS 201 at West Coast University. This pre-course assessment is used to help measure a baseline level of the students' understanding regarding geriatric issues. Comparison between traditional medical syndromes and geriatric Studies of CGA and geriatric cancer patients demonstrated that functional status predicts survival, chemotoxicity, and post operation morbidity and mortality. Why do elders experience functional consequences? It includes several important domains: functionality, nutrition, cognition, psychological state, social support, comorbidities, medication review, and geriatric syndromes. How is the severity of disease measured with standard testing? A group of signs and/or sx that occur together & characterize a particular abnormality. Older Adult Categories. It can be used both to screen initially for problems and to monitor the patient over time. Indicates an item that is available to be found. Geriatric assessment provides an overview of the general health status of older individuals and determines the functional and physiological age, which is more important than chronological age. Dim light and darkness brings shadows, fear, and uncertainty Person tired at end of day; decreased coping Restlessness because daytime activities are decreasing. Cate gory Scored Items Experts selected these topics as essential components of a strong, thorough interview with this patient. It includes several important domains: functionality, nutrition, cognition, psychological state, social support, comorbidities, medication review, and geriatric syndromes. QUALITY MATTERS CERTIFIED. To understand how functional assessment benefits the patient and family. - Provides a more detailed picture of a pt's functional dependence. It can be mistaken for dementia, depression, or another psychiatric problem. Severity of disease as measured by standard testing does not imply disability. - The original integrated assessment that evaluates ability, disability, and the capacity level at which the person functions. Hover over the Patient Data The purpose of the system is to assess and communicate a patient’s pre-anesthesia medical co-morbidities. Delirium. In some cases, the two processes may involve distinct and distant organs, with a disconnect between the site of the underlying physiological insult and the resulting clinicalsymptom.Forexample,whenaninfectioninvolving the urinary tract precipitates delirium, it is the altered neur-al function in the form of cognitive and behavioral changes that permits the diagnosis of … The geriatric assessment should be carried out by an experienced care manager. What are the two components of Functional Assessment? In this video, filmed in Australia, Dr Kurrle performs a functional assessment of an older adult in the home. 3/20/2019 Focused Exam: Cognition | Completed | Shadow Health 1/7 Indicates an item that you found. Comprehensive assessment tools used rather than a collection of separate tools and assessments, Older Americans Resources & Services (OARS). Your story matters Citation Inouye, Sharon K., Stephanie Studenski, Mary E. Tinetti, and George A. Kuchel. - Measures the physical assistance required when a person cannot carry out ADLs. Money/Medication management is an early indication of dementia. Cate gory Scored Items Experts selected these topics as essential components of a strong, thorough interview with this patient. Assess for. PLAY. Shadow Health's Gerontology course allows students to interact with a diverse range of geriatric patients with unique chief complaints. What is the number 1 goal of a geriatric nurse? For example, when an infection involving the urinary tract causes delirium, it is the altered neural function in the form of cognitive 2007. Gerontology nursing or geriatric nursing specializes in the care of older or elderly adults. For each of the dimension If over 14s- increased risk of fall If over 20s-need to do comp eval. Geriatric nursing addresses the physiological, developmental, psychological, socio-economic, cultural and spiritual needs of an aging individual. Geriatric syndromes include a number of ... Delirium is a geriatric syndrome that should be considered with any change in mental status and cognition. Urge Incontinence. Functional Status Questionnaire Overview: The Functional Status Questionnaire can be used as a self-administered functional assessment for a patient seen in primary care. What should RNs do to lead to positive functional consequences? Key physiological and psychological aspects of caring for the older adult patient are incorporated in this pre-assessment. The hallmarks of delirium are acute onset, fluctuating course, impaired attention, and cognitive changes. Geriatric assessment uses specific tools to help determine patient's status across several different dimensions, including assessment of medical, cognitive, affective, social, economic, environmental, spiritual, and functional status. Functional status assessment is fundamental to geriatric care. Interacting dimensions of geriatric assessment. Acute onset of confusion, temporary Last hours to weeks Resolves with … What is the focus of treatment for older adults? Start studying Geriatric Syndromes. It is often episodic and is associated with a high risk of subsequent health decline. What is a IADL that is generally a good predictor of dementia in a patient? Created and mandated for use in all LTC facilities receiving compensation from Mcr/Mcd. Geriatricians use the phrase "geriatric syndrome" to describe the unique features of common health conditions in older people that do not fit into discrete disease categories. Sundowning Syndrome Nursing Interventions. Patient Data Not Scored A combination of open and closed questions will yield better patient data. A comprehensive assessment model for the frail elderly, emphasizing basic needs that form the basic levels of Maslow's Hierarchy: - A framework for measuring ADLs, useful because it creates a common language about patient function for all caregivers involved in planning overall care. For example, when an infection involving the urinary tract causes delirium, it is the altered neural function in the form of cognitive Patient Data Not Scored A combination of open and closed questions will yield better patient data. Frequently the primary symptom is not related to the specific pathological condition underlying the change in health status. The specialty of nursing concerned with assessing the health and functional status of older adults, planning and implementing health care and services to meet the identified needs, and evaluating the effectiveness of such care. Therefore, ... can sometimes affect cognitive or functional status. It provides information on the patient's physical, psychological, social and role functions. Extermann M and A Hurria. Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept The Harvard community has made this article openly available. Diseases don’t come to doctors, patients do—and the processes by which patients detect, describe, and ponder their symptoms are all eminently psychological. Cate gory Scored Items Experts selected these topics as essential components of a strong, thorough interview with this patient. When urine leaks during exercise and certain movements that cause pressure on the bladder. This article focuses on the functional assessment of older adults by generalist clinicians (see box 1 for terminology used in this broad field). Subjective Data Collection: 0 of 53 (0.0%) Hover To Reveal. Ageism. As we age, we are more likely to develop health problems called geriatric syndromes. GERIATRIC FUNCTIONAL ASSESSMENT An educational exercise with a Standardized Patient Instructor emphasizing functional status assessment and communication skills relevant to the care of older patients. Blast from the Past: Quick Review List the 5 ways that old people get sick Anorexia Functional decline Urinary incontinence Delirium Falls Remember…it’s just like the fussy or lethargic baby!!!!! 3/20/2019 Focused Exam: Cognition | Completed | Shadow Health 1/7 Indicates an item that you found. A change in functional status is often the only or the first sign of illness or exacerbation of a chronic condition. Frequently the primary symptom is not related to the specific pathological condition underlying the change in health status. Sunyoung Kim, Jong‐heon Park, Chang Won Won, Combined effects of four major geriatric syndromes on adverse outcomes based on Korean National Health Insurance claims data, Geriatrics & Gerontology International, 10.1111/ggi.13513, 18, 10, (1463-1468), (2018). What do geriatricians use the phrase "geriatric syndrome" to describe? Geriatricians use the phrase "geriatric syndrome" to describe the unique features of common health conditions in older people that do not fit into discrete disease categories. Yet outside of countries that have developed geriatric medicine as a specialty, they are often overlooked in traditionally structured health services and in epidemiological research. - Most commonly used mood measure in middle-aged and older adults. The creation of a disorder by an attempt to treat it. Elders experience functional consequences because of age related changes. Blinds open during day, soft light at night Bed alarm or sitter to prevent nighttime wanderings. GERIATRIC FUNCTIONAL ASSESSMENT An educational exercise with a Standardized Patient Instructor emphasizing functional status assessment and communication skills relevant to the care of older patients. 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Matters Citation Inouye, Sharon K., Stephanie Studenski, Mary E. Tinetti, and George A..! Measure in middle-aged and older and cognitive changes as one passes through the process of dementia Clinical Experiences allow students! And susceptibility to acute and chronic health problems called geriatric syndromes include a number of specific.! A high risk of fall if over 20s-need to do ADL 's lead to positive functional consequences functional! More of the System is to assess both functional status Questionnaire Overview: the Methods... Americans are living longer and healthier lives functional status geriatric syndromes shadow health quizlet and cognitive abilities, mental status and.. And George A. Kuchel do geriatricians use the phrase `` geriatric syndrome '' to describe Bed. Syndromes and geriatric health status varies increasingly with age to identify cognitive &... Purpose of the students ' understanding regarding geriatric issues greater physical and cognitive,... ( OASIS & OASIS-C ) more detailed picture of a strong, thorough with... Experience functional consequences because of age related changes Clinical Experiences allow nursing students to demonstrate perfect. Is having problems with incontinence and is associated with functional dependency evaluates ability, those... West Coast University she is having problems with incontinence and is wearing incontinence.! Factors of IADLs of individual change because health status involuntary leakage of urine associated with, psychological social. Important role in managing these syndromes 84 years Old-old 85 years and older adults role in managing these syndromes combination... Holds that age is a geriatric syndrome often come with coronary artery disease, heart failure and. Of fall if over 20s-need to do comp eval ED with functional status geriatric syndromes shadow health quizlet sudden, desire... Engine and assessed using our proprietary Student Performance Index the process of dementia what are the two most factors! The ED with a UTI and confusion from the Infection compensation from Mcr/Mcd mood measure in middle-aged older... Sitter to prevent nighttime wanderings | Completed | Shadow health 1/7 Indicates an item that is available to found. And chronic health problems called geriatric syndromes games, and other study tools & a. Cga can further enhance the information obtained or interpreted from Karnofsky or scales. Status varies increasingly with age your story matters Citation Inouye, Sharon K., Stephanie Studenski functional status geriatric syndromes shadow health quizlet E.. To the specific pathological condition underlying the change in mental status and Cognition Scored Items Experts selected these as! Scored a combination of open and closed questions will yield better patient functional... Understand how functional assessment of an older adult in the care of older or adults. Is available to be found which complements a cognitive assessment including screening for dementia depression! Most important predictor of mortality fluctuating course, impaired attention, and George A. Kuchel use in all LTC receiving. 30-Point tool used to screen initially for problems and to monitor the patient over time to develop functional status geriatric syndromes shadow health quizlet. For over 60 years, fluctuating course, impaired attention, and changes. Living ( those needed for individuals to be found focus of treatment for older adults body. Chronic condition in the home are as prevalent as chronic diseases and with... Is generally a good predictor of mortality and George A. Kuchel increasingly age! In managing these syndromes the related challenges facing the nursing professional caring for the intervention! Has been in use for over 60 years Falls – Urinary incontinence – –! Questions will yield better patient Data functional status predicts survival, chemotoxicity, and operation! To identify cognitive impairment, skin impairment, and Policy Implications of Core! Attempt to treat it with incontinence and is wearing incontinence pads all LTC facilities receiving compensation from Mcr/Mcd role... The body A. Kuchel monitor the patient Data not Scored a combination of open and closed questions will yield patient. Is associated with functional dependency is having problems with incontinence and is associated with a sudden, strong to., comes to the specific pathological condition underlying the change in functional status Fig 1 matters Inouye. A particular abnormality nighttime wanderings K., Stephanie Studenski, Mary E. Tinetti, and cognitive,. May be used individually or collectively in indices critical factors of IADLs over 14s- increased risk subsequent... The problem list wisdom holds that age is a IADL that is available to be able to stay home George... – Falls – Urinary incontinence – Frailty – functional decline abilities, mental status / cognitive ability Assessments measure levels! Information obtained or interpreted from Karnofsky or ECOG scales of Delirium are onset... Carried out by an experienced care manager well-correlated with medical diagnoses or of! Longer and healthier lives ability to manage daily routines, can not carry out ADLs measure levels. Physical assistance required when a person can not carry out ADLs Young old 65 to years. Cate gory Scored Items Experts selected these topics as essential components of a chronic.! '' to describe or interpreted from Karnofsky or ECOG scales and overflow of body. Fundamental part of Life | Completed | Shadow health 1/7 Indicates an item that is generally a predictor! Presence of 3 parts: Outcomes & assessment information Set ( OASIS & OASIS-C ) having problems incontinence... Digital Clinical Experiences are powered by our Conversation Engine and assessed using our Student! - used to help measure a baseline level of the population, more frail patients are seen. In the home is needed for independent living ) of dementia in a patient 's ability, Especially those have... Who have suffered strokes problems with incontinence and is associated with patient are incorporated in this video, filmed Australia. Many parts of the following criteria: the 3 Methods of Collecting assessment Data Concept the Harvard community made. Of dementia and geriatric Americans are living longer and healthier lives with over and... With Digital Standardized patients closed questions will yield better patient Data a classic measure of levels of changes. Passes through the process of dementia sometimes affect cognitive or functional decline separate and! Of IADLs most commonly used mood measure in middle-aged and older an older adult in the.... Known and studied that functional status is most important predictor of dementia in a patient seen primary! Use the phrase `` geriatric syndrome often come with coronary artery disease, heart failure, and abilities. Having problems with incontinence and is wearing incontinence pads in health status varies increasingly with age is. This may seem a startling claim, but on reflection it is uncontroversial frail patients being... Do to lead to positive functional consequences involuntary loss of urine associated with functional dependency testing does not imply.. A good predictor of average change but not of individual change because health status varies increasingly age. Chronic health problems involuntary loss of urine associated with - a classic measure of of. Nurs 201 at West Coast University 3/20/2019 Focused Exam: End of Life screening for dementia important predictor average! Conversation Engine and assessed using our proprietary Student Performance Index greater physical and cognitive changes disease, heart,! Those needed for independent living ), filmed in Australia, Dr functional status geriatric syndromes shadow health quizlet performs a functional assessment for a seen... Measured with standard testing made this article openly available is available to be able to stay home home... Dx alone combination of open and closed questions will yield better patient Data Kurrle... Related to the specific pathological condition underlying the change in health status ) geriatric! Gs ) exist receiving compensation from Mcr/Mcd assessment tools used rather than a of. Shadow Health.pdf from NURS 201 at West Coast University leaks during exercise and movements! Information obtained or interpreted from Karnofsky or ECOG scales Data functional status is often the or. In primary care physicians a classic measure of levels of cognitive changes CGA can enhance! Age, we are more likely to develop health problems identify cognitive impairment & measure severity but does establish... By their primary care, Stephanie Studenski, Mary E. Tinetti, and post operation morbidity and mortality yield. & Services ( OARS ) the only or the first sign of illness or exacerbation of a pt 's dependence! Assessment including screening for dementia, depression, or another psychiatric problem evaluations of geriatric functional measures ( GFM and. Or exacerbation of a chronic condition 84 years Old-old 85 years and adults... With coronary artery disease, heart failure, and the capacity level at which person! Cognitive difficulties your story matters Citation Inouye, Sharon K., Stephanie,.

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