AIMST UNIVERSITY

GERIATRIC POSTING

LOG BOOK

Name of Student : ……………………………………………………………

ID No : ……………………………………………………………………………..

Batch : …………. Group : …………. Date : …………………………………

Location : ………………………………………………………………………..

Asso:Prof :Dr. Sawri Rajan Rajagopal

HoU
Family Medicine Unit
 CONTENTS

N Subject Page No
o
1 GUIDELINES IN EXAMINATION OF THE ELDERLY

2 FACTORS TO NOTE IN LONG CASES

3 DEPRESSION QUESTIONAIRE

4 PRACTICE DIARY - GERIATRICS

5 Student Evaluation

6. The Mini Mental State Examination (Mmse)

7. Score Orientation

8. Sentence (Picture)
NAME OF COURSE: GERIATRIC MEDICINE – 1 WEEK POSTING

YEAR OFFERED YEAR 5

HOU ASSOC PROF DR SAWRI RAJAN RAJAGOPAL

ACADEMIC STAFF INVOLVED ASSOC PROF DR SAWRI RAJAN RAJAGOPAL

ASSIT: PROF DR.TIN SOE@SAIFULLAH BIN HASHIM

DATUK DR CH’NG KOK HEOWG (04 7332737)

RATIONALE OF THE COURSE

The Malaysian government has formulated a national policy for older persons, and
the Ministry of Health has begun to include health of older people in its expanded
Primary Health Care Service (at Klinik Kesihatan Levels

The common problems in the elderly will be addressed through a one wwek
posting at a Home for the Elderly at Pokok Sena. Focus will be on history taking
and physical examination of the elderly and the understanding the following
commonly encounttered health conditions among the elderly.

• Dementia, Depression, Delerium

• Incontinence
• Osteoporosis
• Falls
• Hearing and vision impairment
• Sleep disorders
• Failure to thrive
.Iatrogenic (medications)
GUIDELINES IN THE EXAMINATION OF THE ELDERLY

 HISTORY TAKING (Make note of comorbid state)

 GENERAL EXAMINATION (Look for)

1. Consciousness
2. Pallor
3. Jaundice
4. Pedal Oedema
5. Hydration
6. Skin
7. Arcus Snilis
8. Venous Ulcers
9. Pressure Sores
10. Leukoplakia
11. Dental pathology/Dentures
12. Abdominal distension
13. Barrel chest
14. Kyphosis

 VITAL SIGNS
 SYSTEMIC / PHYSICAL EXAMINATION
 DIFFERENTIAL DIAGNOSIS/PROVISIONAL DIAGNOSIS
 MANAGEMENT
 PROGNOSIS
FACTORS TO NOTE IN LONG CASES

1. Atypical presentations
2. Late presentations
3. Presence of multiple pathologies and cormorbidities
4. The common problems to look out for
a. Falls
b. Depression
c. Orientation in time,place and person
d. Dementia ( perform MMSE)
e. Behavioral changes
f. Memory
g. Gait
h. Spasticity / rigidity
i. Immobility
j. Incontinence
k. Pressure sores
l. Painful joints
m. Confusion
n. Constipation
o. Breathlessness
p. Dizziness / Giddinesas
q. Anaemia
r. Dehydtation / Fluid balance
s. Chronic infections
t. Strokes
u. Peptic ulceration / GERD
v. Visual impairment
w. Hearing impairment
x. Organ failures
y. Malignancies
z. Prostate Enlargement

DEPRESSION QUESTIONAIRE
Please fill up this questionnaire for the elderly patient you encounter
 Patient Code No: Ethnic Group Age

Location of Stay: Past/Present Occupation:

Married/Divorced/Single: No of Children………… M…..F…..

Staying at/with:………… Economic State: Pensioner/Dependent/Welfare Dept /Self Sufficient

To a
Not Only Quite
Questions: Partly A lot great
at all slightly a lot
extent
Do you do things slowly.
Do you feel you future seems hopeless.
Do you find it hard to concentrate when you read.
Do you feel all joy and pleasure seem to have
disappeared.
Do you find it hard to make decisions.
Have you lost interest in things that used to mean a
lot to you
Do you feel sad, depressed and unhappy.
Do you feel restless and unable to relax.
Do you feel tired.
Do you find it hard to do even trivial things.
To a
Not Only Quite
Questions: Partly A lot great
at all slightly a lot
extent
Do you feel guilty and deserve to be punished.
Do you feel you are a failure.
Do you feel empty - more dead than alive.
Do youfeel your sleep is disturbed: too little, too
much or disturbed sleep.
Do you wonder HOW you could commit suicide?.
Do you feel confined and imprisoned.
Do you feel down even when something good
happens to you
Have you lost or gained weight without being on a
diet.
 PRACTICE DIARY
Record from the Geriatric posting/palliative posting 5 varied cases
Pt Pt Age Sex Race O/N FP Reason for History Diagnosis Investigation Management
No. ID visit

5
LONG CASE :

Name of the Patient :

Age :

Sex :

Occupation :

Race :

Religion:

Nationality :

Place :

a. Presenting Complaints with Duration :

( in Chronological order )

b. History of Present illness :

c. Past history ( from Childhood) :

d. Previous treatment / drug intake / Drug Abuse / drug allergy if any :

e. Family History :

f. Occupational histoty :
g. Menstrual history :
 Age of Menarche
 Menstrual history
 Obstetric history Para ……………….. Gravida ……………………….
 Age of menopause

h. Daily habits/rountine :

i. Systemic enquiry :

j. Physical Examination (General) :

k. Systemic examination ( should include examination of all the relevant system):
l. Summary of the Case:

m. Provisional Diagnosis :

n. Laboratory Investigations (Clinical lab and Imaging):

o. Definitive Diagnosis :

p. Suggested Treatment :

q. Follow –up :

Date:
THE MINI MENTAL STATE EXAMINATION (MMSE)
Cognitive impairment is no longer considered a normal and inevitable change of
aging. Although older adults are at higher risk than the rest of the the population,
changes in cognitive function often call for prompt and aggressive action.In older
patients, cognitive functioning is especially likely to decline during illness or injury.
The doctor’s assessment of an older adult’s cognitive status is instrumental in
identifying early changes in physiological status, ability to learn, and evaluating
responses to treatment. - BEST TOOL :
The Mini Mental State Examination (MMSE) is a tool that can be used to
systematically and thoroughly assess mental status. It is an 11- question measure
that tests five areas of cognitive function: orientation, registration, attention and
calculation, recall, and language.The maximum score is 30.A score of 23 or lower
is indicative of cognitive impairment.

The MMSE takes only 5 – 10 minutes to administer and is therefore practical to

use repeatedly and routinely.
TARGET POPULATION: The MMSE is effective as a screening tool for cognitive
impairment with older, community dwelling, hospitalized and institutionalized
adults.

Assessment of an older adult’s cognitive function is best achieved when it is done

routinely, systematically and thoroughly.

VALIDITY / RELIABILITY : Since its creation in 1975,the MMSE has been validated
and extensively used in both clinical practice and research.

STRENGTHS AND LIMITATIONS: The MMSE is effective as a screening instrument

to separate patients with cognitive impairment from those without it. In addition,
when used repeatedly the instrument is able to measure changes in cognitive
status that may benefit from intervention. However, the tool is not able to
diagnose the case for changes in cognitive function and should not replace a
complete clinical assessment of mental status. In addition, the instrument relies
heavily on verbal response and reading and writing. Therefore, patients that are
hearing and visually impaired, intubated, have low English Literacy, or those with
other communication disorders may perform poorly even when cognitively intact.
(To be filled in by the Family Medicine Specialist/AIMST Coordiantor)

STUDENT EVALUATION

STUDENT NAME:………………………………………………… ID NO …………………………………

Year………….BATCH …………… Group……………..

(A final year medical student at AIMST UNIVERSITY .SEMELING.KEDAH )During the last year of the 5
years training they are expected to complete 2 weeks of FAMILY MEDICINE posting at the end of which
they are to be evaluated by the Family Physician at the Primary Health Care Clinic where they
underwent the necessary training.

KNOWLEDGE:
 Knowledge in the field of Family Medicine Excellent Good Satisfactory Poor
 Ability to use that knowledge in clinical situations in a
clear and effective manner.
SKILLS
 Punctuality
 Ability to carry out physical examination and history
taking
 Ability to formulate realistic diagnoses.
 Confidence in presentations.
 Communication with patients.
 Efficiency and effectiveness in documentation
ATTITUDE
 Motivation at work
 Professionalism in dress and demeanor.
 Dependability and trustworthiness
 Completing assignments with enthusiasm.
 Rapport with staff, physicians, and patients

SIGNATURE OF FMS NAME/COP DATED

Maximum
Score score
ORIENTATION

5 ( ) What is the: (year) ( season) ( date) (month)

5 ( ) Where are we: (state) (county) (town) (facility) (floor)

REGISTRATION

3 ( ) Name three objects and have person repeat them back.Give one
point for each correct answer on the first trial.

1. .................. 2 …………………… 3 …………………

Then repeat them (up to 6x) until all three are learned
[ Number of trials ……………..]

ATTENTION AND CALCULATION

5 ( ) Serial 7’s. Count backwards from 100 by serial 7’s.One point for each
correct answer.Stop after 5 answers. [93 86 79 72 65 ]
Alternatively spell “world” backwards.[D – L – R – O – W]

RECALL

3 ( ) Ask for rthe names of the three objects learned above.Give one point
each correct answer.

LANGUAGE

9 ( ) Name: a pen ( 1 point) and a watch (1 point)

Repeat the following: No ifs, ands, or buts ‘’ (1 point)
Follow a three –stage command: Take this paper in your
[non-dominant] hand,fold it in half and put it on the floor”.(3 points)
[1 point for each part correctly performed]
Read to self and then do: Close your eyes”( 1 point )
Write a sentence [subject,verb and makes sense] (1 point)
Copy design [sided geometric figure; 2 points must intersect](1point)

Score : / 30 Alert Overtly Anxious Concentration Difficulty Drowsy

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CLOSE YOUR EYES

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