Geriatrics consult guide

Geriatrics consult guide

Jan 23, 2019 0
onthephones

Contributor:  Sally Bath

Editor:  Georgette Goode

Reviewed:  Fiona Tran

  • Exactly what you are asking the geriatrician to do – ask your registrar or consultant if unsure. Common reasons include: approval for ACAT assessment, prolonged delirium, capacity assessment, diagnosis and management of cognitive impairment.
  • The patient’s baseline level of function/independence/cognitive function. You may need to gather collateral history from family, etc.
  • Goals of care for the patient, including resuscitation status.
  • Is the patient known to a geriatrician? When were they last seen? If possible, you should obtain any relevant letters from the geriatrician’s rooms/clinic prior to calling for the consult.
  • The baseline level of cognitive function. (A cognitive history from family and results of recent cognitive screens i.e. MMSE/ MoCA/RUDAS/ACE-III.)
  • Medication history – engage your helpful pharmacist or call local pharmacy yourself. (NB: sleeping tablets are often taken and not reported.)
  • Social history, including alcohol intake.
  • Functional background, including personal and instrumental activities of daily living.
  • A cognitive screening test (commonly used tests include MMSE, MoCA, RUDAS).
  • Occupational therapy, physiotherapy and social work assessments.
  • If the patient is delirious: workup to exclude reversible cause such as infection – bloods, CXR, UA/MSU and blood cultures, consider delirium pathway including regular CAM (see reference).
  • Discuss with registrar regarding need for a cerebral imaging if not previously performed – useful in assessment for reversible causes of cognitive impairment or initial diagnosis.
  • Collateral history from local GP and community care providers.
  • Not having arranged allied health assessments prior to requesting the consult – this is likely to be the first thing the geriatrics registrar asks you to do, especially if the request is for an ACAT assessment.
  • They are likely only to consider taking over care if the patient has multiple complex medical or social issues that require specific geriatric input.
  • Not chasing collateral history from family members/carers – is the current level of function different from baseline or are they at their usual level?

Helpful Resources

Tags: #ACAT assessment,#cognitive impairment,#consult guide,#delirium,#dementia,#Geriatrics,#junior doctors,#requesting a consult

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