Review the course library page list of available screening tools.

This is a graded discussion: 50 points possible

due Jul 28, 2019

Week 3: Geriatric Assessment Tools

1414 unread replies.3636 replies.Students will not receive credit for any discussions posted after Sunday 11:59pm MT.Review the course library page list of available screening tools.Scroll down and look on the left hand side of the screen: Geriatric Assessment tools Choose two assessment tools that are appropriate for primary care (excluding

depression, anxiety and pain screening tools) and discuss the following:

 explain the purpose of the tool  scoring guidelines  how you apply the assessment in practice *If you would like to present a screening tool that is not listed, contact your instructor for approval.

Discussion Guiding Principles The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of discussions provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the discussion generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. Discussions foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.Participation Guidelines Students must post a minimum of two times in each graded discussion. The two posts in each individual discussion must be on separate days. Posting twice on two different days meets the minimum requirement however for full credit, the student must post at least three substantive posts on three different days. The student must provide an answer to each graded discussion topic posted by the course instructor, by

Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion in which the late entry occurs (up to a 10 point deduction for that week). Subsequent posts, including essential responses to peers,

must occur by Sunday, 11:59 p.m. MT at the end of each week. Week 8 only-

Subsequent posts, including essential responses to peers, must occur by Saturday,

11:59 p.m. MT of Week 8.

Direct Quotes Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.Search entries or author Filter replies by unreadUnread Collapse replies Expand replies Subscribed  Collapse Subdiscussion Ziki Wongyip Ziki Wongyip

Jul 21, 2019Jul 21, 2019 at 10:36pm

Manage Discussion Entry Explain the purpose of the tool The BODE index is a tool that is a mortality prediction from COPD. It is a tool that is used by healthcare professionals to evaluate as a prognostic factor in COPD. The BODE index was calculated for each patient based on the following variables: exercise tolerance (walking distance in 6 minutes), dyspnea, FEV1, and

body mass index (BMI). Four quartiles were defined: quartile 1 (score between 0

and 2), quartile 2 (score between 3 and 4), quartile 3 (score between 5 and 6), and quartile 4 (score between 7 and 10) (Ketata, Abid, Feki, Msaad, Bahloul, & Ayoub, 2015).. Using points based on 4-dimensional measures of lung function, the BODE score makes a reliable for measuring the systemic impact of COPD on quality of life.The Montreal Cognitive Assessment (MoCA) is an accurate test to detect individuals with mild cognitive complaints. It is a useful tool for predicting the development of dementia in patients with mild cognitive impairment (Tromop-van

Dalen, Thorne, Common, Edge, & Woods, 2018). This test is validated in the primary care setting to determine whether an individual has abnormal cognitive function.Scoring guidelines Four different factors are evaluated as part of the BODE index. The BODE stands for B- body mass index (BMI), O - Airway obstruction, D – Dyspnea, E - Exercise tolerance. BMI is a calculation that is made by comparing height in meters by weight in kilograms. Being underweight is a poor sign when it comes to COPD prognosis. Thus, 0 point is for a BMI greater than 21 and 1 point for a BMI of less than 21. Airway obstruction is measured by evaluating FEV1. The severity of dyspnea was assessed with the modified Medical Research Council (mMRC) dyspnea scale. 0 points for an FEV1 greater than 65%, 1 point is for an FEV1 of 50-64%, 2 points for an FEV1 of 36-49%, 3 points for an FEV1 of less than 35%.The severity of dyspnea was assessed with the modified Medical Research Council (mMRC) dyspnea scale (Ketata, Abid, Feki, Msaad, Bahloul, & Ayoub, 2015). In this

measurement, dyspnea is measured on a scale of 0 to 4: mMRC 0 - not troubled by

breathless except on strenuous exercise. mMRC 1 - short of breath when hurrying on a level or when walking up a slight hill. mMRC 2 - walks slower than most people on the scale, stops after a mile or so, or stops after 15 min walking at own pace. mMRC 3 - stops for breath after walking 100 yards, or after a few minutes on level ground. mMRC 4 - too breathless to leave the house or breathless when dressing/undressing (Williams, 2017). Exercise testing refers to how well some does on a 6-minute walk test. 0 point if a patient can walk over 350 meters, 1 point if a patient can walk 250-249 meters, 2 points if a patient can walk 150-249 meters,

• points if a patient can walk 149 meters or less. After obtaining a BODE index, the

survival rate can be predicted. The BODE index scores measured were categorized into four quartiles, quartile 1 to 4 with scores of 0-2, 3-4, 5-6 and 7-10, respectively (Ketata, Abid, Feki, Msaad, Bahloul, & Ayoub, 2015). Higher BODE quartiles were associated with a higher mortality rate.The MoCA test has 30 questions assessing various domains of cognition and can be performed in 10 minutes. It is widely used in over 100 countries and is available in 46 languages and dialects. In the validation study, the sensitivity and specificity of the MoCA for detecting mild cognitive impairment were 90% and 87% respectively, compared with 18% and 100% respectively for the MMSE (Tromop- van Dalen, Thorne, Common, Edge, & Woods, 2018). Scores on the MoCA range from zero to 30, with a score of 26 and higher generally considered normal. The

scoring breakdown into as following: short-term memory (5 points), visuospatial

functions (4 points), executive functions (4 points), language (5 points), orientation to time and place (6 points), attention (5 points), education (1 point). In education domain, 1 point is given to the test-taker's score if patient has 12 years or less of formal education (Borland, Nägga, Nilsson, Minthon, Nilsson, & Palmqvist, 2017).MoCA test helps predict dementia in people with Mild Cognitive Impairment because it tests for executive function, it is more sensitive in this regard than the MMSE How you apply the assessment in practice

Providers can conduct these two assessment tools to identify issues and to develop an integrated plan for treatment and follow-up. Undetected cognitive impairment can increase the risk of underdiagnose and undertreatment. For example, many patients notice gradually increasing forgetfulness as they age. They often complain about can’t remember what they did and what they ate yesterday.Mild cognitive impairment may increase the risk of developing dementia. Mild Cognitive Impairment is a clinical stage on the continuum of cognitive decline between normal aging and dementia (Langa and Levine, 2014). In this case, providers can use the MoCA test to make a differential diagnosis. MoCA can successfully detect dementia in primary care. Once the diagnosis and causes are identified, the treatment and management can be initiated to prevent disability and deformity.The BODE index was developed as a prognostic mortality risk tool for patients with COPD. It is a multidimensional grading system for COPD that is a better predictor of death than FEV 1 (Ansari et al., 2016). This test can help the provider to gain valuable measurements and information about a patient’s COPD stage and severity. It can also help providers to predict the treatment outcomes for a COPD patient. Because COPD can cause trouble with weight management and nutrition, knowing a patient’s BMI will help provider develop a treatment plan.Dyspnea shows how much shortness of breath affects a patient’s quality of life. The 6-minute walk test shows a patient’s exercise tolerance and exercise capacity.These combined measurements make up the BODE index and give a comprehensive picture to the provider to develop the best treatment plan for the patients.References Ansari, K., Keaney, N., Kay, A., Price, M., Munby, J., Billett, A., … Al Otaibi, H.(2016). Body mass index, airflow obstruction and dyspnea and body mass index, airflow obstruction, dyspnea scores, age and pack years-predictive properties of new multidimensional prognostic indices of chronic obstructive pulmonary disease

in primary care. Annals of Thoracic Medicine, 11(4), 261–268. https://doi-

org.chamberlainuniversity.idm.oclc.org/10.4103/1817-1737.191866 Borland, E., Nägga, K., Nilsson, P., Minthon, L., Nilsson, E. D., Palmqvist, S.

(2017). The Montreal Cognitive Assessment: Normative data from a large Swedish

population-based cohort. Journal of Alzheimer's Disease, 59(3), 893–

901.doi:10.3233/JAD-170203.

Ketata, W., Abid, T., Feki, W., Msaad, S., Bahloul, N., & Ayoub, A. (2015).Comparison of forced expiratory volume (FEV1) and BODE index in the assessment of health-related quality of life in patients with chronic pulmonary disorder. African Journal of Respiratory Medicine, 10(2), 4–7. Retrieved from

https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?

direct=true&db=a9h&AN=102140022&site=eds-live&scope=site Langa, K. M., & Levine, D. A. (2014). The diagnosis and management of mild

cognitive impairment: A clinical review. JAMA, 312(23), 2551-2561.

doi:10.1001/jama.2014.13806

Tromop-van Dalen, C., Thorne, K., Common, K., Edge, G., & Woods, L. (2018).Audit to investigate junior doctors’ knowledge of how to administer and score the