As with any patient, you should assess past medical history, family history, medications, and a social history. The functional assessment is central to a geriatric interview. This includes asking the patient and caregiver about the patient’s ability to perform Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs). Clinicians should also inquire about vision and hearing, nutrition and weight, balance and gait, cognition, mood, and social supports. (This information need not be obtained in one meeting.) A geriatric assessment should also screen for geriatric syndromes, including falls, memory changes, incontinence, frailty, and polypharmacy.
Fortunately, much valuable information can be gathered from patient report, family information, and review of the medical record. Many aspects of a cognitive assessment can be easily incorporated into a video visit along with the psychiatric mental status examination. Geriatric psychiatry is often family psychiatry. Involving trusted caregivers in these video assessments is invaluable whenever possible.
Setting up video visits for geriatric patients:
General suggestions for communicating via video:
Physical examination findings that can be readily obtained in the home or by video:
Mental status examination:
Assessment of appearance, behavior, speech and language, emotional state, thought content and process, cognition, and insight are no different when performed via video visit and in the clinic.
In speaking with a patient by telephone, the clinician is often able to garner sufficient information to comment accurately on a patient’s cognition, speech and language, mood state, and thoughts. Without observing the patient, information is lost with regard to appearance and affect, which can be valuable clinical clues to gauging a patient’s mood and anxiety.
Physical examination findings that can be modified:
Screening tools in geriatric psychiatry:
Screening tools can also be readily used in a virtual visit or easily modified. These include the Montreal Cognitive Assessment (MoCA) and Geriatric Depression Scale (GDS).