Hello, mrsarc-ga
Two examples of excellent, extremely comprehensive senior health and
fitness assessments are provided by the programs offered at the
University of California, Irvine and Mount Sinai Hospital in New York.
The components of each program are included in the following
descriptions.
The Health Assessment Program for Seniors (HAPS) at the University
of California, Irvine, provides a comprehensive approach to
age-related problems, addressing physical and mental function,
environmental factors and illnesses commonly associated with aging and
long-term planning.
Components of the evaluation:
1. A psychosocial evaluation at home
2. An evaluation at the medical center. This includes an in-depth
physical, a medication review, and evaluations by a neuropsychologist,
dietician and occupational therapist.
3. Once the assessment has been completed, the HAPS team meets with
the patient and family to discuss the sources of identified problems
and to plan appropriate care. Typically, two visits are needed for
appropriate testing and the family conference. The family and
patient’s primary care physician receive a full, written report of the
patient’s condition. Depending on the patient’s needs, the report may
recommend resources as well. In some cases, he or she will be referred
back to the family doctor, followed by HAPS physicians, or cared for
by both.
Read “Health Assessment Program for Seniors.” UCI Medical Center at
http://www.ucihealth.com/HealthcareServices/haps.htm
Mount Sinai's “60+ Senior Health Program” is even more comprehensive.
“One of the foremost geriatric centers in the world, Mount Sinai
offers a comprehensive medical assessment for older adults who are
ready to take the guesswork out of maintaining a healthier, more
productive life. The program was designed specifically for senior
executives, active retirees, and mature men and women over 60 years of
age seeking to maximize their functional capacity and extend the
quality of their lives.”
“Components of the 60 Plus Comprehensive Health Examination:”
Complete history and physical examination
Neurological examination
Review of medications/interactions and doses
Mental status assessment
Screening for colon cancer
Depression screening
Functional assessment
Gait and falls assessment
Nutritional screening
Urinary incontinence evaluation
Assessment of dysfunctional bowel
Sexual function evaluation (optional)
Assistive device assessment
Hearing and vision screening
Osteoporosis evaluation
Peripheral vascular disease screening
Psychosocial assessment
Cardio-pulmonary disease screening
Vaccinations: pneumovax, tetanus/diphtheria, influenza (seasonal)
Urinalysis
Blood tests to screen for nutritional deficiencies, abnormal
cholesterol, anemia, diabetes, abnormal liver and kidney function, and
reversible causes of memory loss.
Gynecological examination and pap test
Mammogram
Prostate screening
Counseling on specific health related issues, such as nutritional
guidelines for obesity, heart disease, diabetes, malnutrition and
aspiration, as well as osteoporosis, memory loss, and depression
Exercise guidelines
Informational materials on specific medical topics
Advice on safety issues in the home
Family counseling
Assistance with end-of-life issues
Refer to the website at
http://www.msnyuhealth.org/hospitals/msh/international/content/intl_60plus.html
for additional information.
Because both the UCI Health Assessment Program for Seniors and the
Mount Sinai program are so comprehensive, including evaluations by a
neurophyschologist, dietician, and in-depth physicals, they should be
used as a model for you to follow if such an inclusive program does
not exist in your area. Major hospitals are a good resource for
various specialty doctors, and usually offer a good geriatric
dietician and a senior health and stress-testing center.
“Chemical imbalances that may cause moodiness or depression” would be
best diagnosed by a psychiatrist or neurophyscologist.
A geriatric dietician/nutritionist would be the best resource for
determining nutritional imbalances. A nutritionist would either
determine deficiencies by blood tests and/or dietary questionnaires.
Problems with assessing nutritional deficiencies in seniors is
reviewed in an article by The Mayo Clinic’s Division of Geriatric
Medicine titled “Practical Functional Assessment of Older Persons” at
http://www.mayo.edu/geriatrics-rst/PFA.html.
“Determining whether an elderly patient is malnourished is
surprisingly difficult. Measures used to assess nutritional status in
younger patients (which typically rely on such factors as height,
weight, age and lean body mass) have not been validated in the
elderly. Skeletal height decreases with age, the proportion of lean
body mass decreases, and the proportion of adipose tissue increases.
Therefore, standard height/weight tables and the Body Mass Index
nomograms may be unreliable in older adults, and are of unproven
utility in screening for malnutrition.”
“No reliable laboratory measures have been validated as effective
tools in screening for malnutrition in the elderly. The anemia,
hypoalbuminemia, and lymphocytopenia known to accompany malnourished
states may indicate acute or chronic illnesses and are not reliable
screening markers of undernutrition in older adults.
Hypocholesterolemia (total cholesterol less than or equal to 160
mg/dL) in the eldery is associated with increased morbidity and may be
a marker of malnutrition, but this is a nonspecific finding.
Therefore, screening cholesterol testing is not recommended.”
“Perhaps the most useful indicators of nutritional status in elderly
patients are a loss of weight from baseline or the development of
anorexia. Weight loss of more than 5 percent of total body weight (or
5 pounds) in one month or more than 10 percent (or 10 pounds) in six
months is significant. However, since self-reported weights can be
inaccurate, it is essential to record the weights of elderly patients
on a regular basis (on each visit or every six to twelve months) in
order to document any weight loss.”
“Patients unaware of declining weight may acknowledge clothes fitting
more loosely or belts notched more tightly. Diet diaries, rather than
diet interviews, can give useful historical data about food intake.
Physical examination for signs of malnourishment (jaundice, cheilosis,
glossitis, loss of subcutaneous fat, muscle wasting, edema) can
sometimes provide additional clues. Combining historical data about
changes in weight, appetite, and clothing with serial weight
measurements may be the most useful method to assess nutritional
status in the elderly.”
A short “Excerpt from the American Journal Clinical Nutrition 2001;
71:590-59” at http://www.realityhealthresearch.com/elderly.html
stresses two important findings about senior nutrition:
1. If you have a "normal" blood test, you may still have nutritional
deficiencies
2. A "good" diet alone is not enough, especially in the elderly.
A test for Live Blood Cell Analysis, which I can not vouch for, is
one possiblity for determining the efficiency of supplementation.
“Live blood cell analysis is a screening test for hematological
status using darkfield, phase contrast and brightfield
microscopy.Using the microscope in this way, we can evaluate the
properties of individual blood cells thus allowing a multitude of
nutritional deficiencies and disorders to be detected. These disorders
include some conditions that cannot be easily detected with the
traditional method of blood analysis. Live blood cell analysis is
really not a diagnostic procedure for specific disease. It is best
used to help determine the optimal diet and food supplements (enzymes,
herbs, antioxidants, etc.) for a given individual in good health or
with chronic illness of almost any kind. One of the benefits of
microscopic blood analysis is that many nutritional disorders can be
detected before standard blood tests can detect any chemical changes.
With this form of testing, treatment can be more successful because
these problems are discovered when they are still in their infant
stages.
For more information, including a contact number, go to the website
at http://www.oxygenhealthsystems.com/lba.html
Other questionable tests for evaluating existing and ongoing
nutritional deficiencies touted by nutritional “therapists” are hair
and blood analysis. I cannot vouch for either of these.
The American Academy of Family Physicians has several
self-assessments which can be undertaken before visiting your doctor.
The “Geriatric Depression Scale,” the “Nutritional Health Screen,” and
the “Ten-Minute Screen for Geriatric Conditions” (as well as some
other more specific tests) are generally-accepted screens used by
physicians in senior health and fitness assessments. The article, “The
Geriatric Patient: A Sytematic Approach to Maintaining Health,” by
Karl E. Miller, MD. American Family Physician (2/15/2000) can be found
at http://www.geriatrictimes.com/g000823.html
Additional Reading
“Focusing on the Nutritional Needs of Older Americans,” by Richard
Sherer. Geriatric Times (July/August 2000) at
http://www.geriatrictimes.com/g000823.html
I hope this information helps to answer your questions. If you need
further help or clarification, please don't hesitate to ask.
umiat-ga
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