Geriatric EMR Templates The following are templates that can be incorporated into electronic medical record systems to assist in training medical students and residents to provide patient-centered, evidence-based care to geriatric patients. Double underlines are provided after selection items to indicate where one would add a + or –, (reported or denied, Yes or No, observed or absent) or additional information depending on the system being used or where one could expand a macro. Macros that call up additional forms, tools or checklists are indicated in blue highlighting and include a suggested macro key. The first item below is a complete Geriatric Assessment encounter note template. Templates that follow are either specific parts of the encounter note, such as histories (Family, Social, etc.) or the geriatric physical exam. Additional macros are built into these sections which bring up geriatric assessment tools. The last item is a template for the geriatric syndrome in the Assessment portion of the SOAPnote.
The following templates included below are:
Include severity of symptom to patient and distress that symptom causes caregiver
Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.
Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.
Agitation/Aggression: Is the patient stubborn or resistive of help from others__.
Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.
Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.
Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.
Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.
Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.
Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.
Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.
Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.
Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.
1. What is the: Year __. Season __. Date __. Day __. Month __.
2. Where are we: State __. County __. Town __. Hospital/Building __. Floor __.
3. Name 3 Objects: 1 second to say each. Then ask the patient to name all three.
Give 1 point for each correct answer.
0 __. 1 __. 2 __. 3 __.
4. Serial 7's: 1 point for each correct answer.
0__. 1 __. 2 __. 3 __. 4 __. 5 __.
5. Ask for 3 objects repeated above:
0 __. 1 __. 2 __. 3 __.
6. Hold up a pencil and a watch: Ask patient what each is; 1 point for each correct identification.
Pencil __. Watch __.
7. Successfully repeats "No ifs, ands, or buts" __.
8. Follows this 3 stage command:
"Take a paper in your right hand, fold it in half, and put it on the floor"
0 __. 1 __. 2 __. 3 __.
9. Reads and obeys the following statement: "Close your eyes" __.
10. Writes a sentence __.
11. Copies design: __.
Total Points out of 30 = __. (nl 26-30)
15. Confusion Assessment Measures
Both acute onset__. and fluctuating course__. and inattention__. and either disorganized thinking__. or altered level of consciousness__.
16. 2 Question Mood Screen
During the past month,
have you often been bothered by feeling down, depressed or hopeless? __.
have you often been bothered by little interest or pleasure in doing things? __.
Scoring: if patient answers yes to one or both, continue with the GDS __.
17. Geriatric Depression Scale
Geriatric Depression Scale
Choose the best answer for how you felt over the past week.
Are you basically satisfied with your life? No__.
Have you dropped many of your activities and interests? Yes__.
Do you feel that your life is empty? Yes__.
Do you often get bored? Yes__.
Are you in good spirits most of the time? NO__.
Are you afraid that something bad is going to happen to you? Yes__.
Do you feel happy most of the time? No__.
Do you often feel helpless? Yes__.
Do you prefer to stay at home, rather than going out and doing new things? Yes__.
Do you feel you have more problems with memory than most? Yes__.
Do you think it is wonderful to be alive now? No__.
Do you feel pretty worthless the way you are now? Yes__.
Do you feel full of energy? No__.
Do you feel that your situation is hopeless? Yes__.
Do you think that most people are better off than you are? Yes__.
Score 1 point for each + answer. Cut-off: normal 0–5; above 5 suggests depression.
18. Patient Health Questionnaire 9
Patient Health Questionnaire - 9
Over the last 2 weeks, how often have you been bothered by any of the following problems?
KEY: 0 Not at all 1 Several days 2 More than half the days 3 Nearly every day
1. Little interest or pleasure in doing things. 0__. 1__. 2__. 3__.
2. Feeling down, depressed, or hopeless. 0__. 1__. 2__. 3__.
3. Trouble falling or staying asleep, or sleeping too much. 0__. 1__. 2__. 3__.
4. Feeling tired or having little energy. 0__. 1__. 2__. 3__.
5. Poor appetite or overeating. 0__. 1__. 2__. 3__.
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down. 0__. 1__. 2__. 3__.
7. Trouble concentrating on things, such as reading the newspaper or watching television. 0__. 1__. 2__. 3__.
8. Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual. 0__. 1__. 2__. 3__.
9. Thoughts that you would be better off dead, or of hurting yourself in some way. 0__. 1__. 2__. 3__.
10. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all__. Somewhat difficult__. Very difficult___. Extremely difficult___.