Comprehensive Geriatric Assessment Note

Past Medical History

Hypertension Osteoarthritis (bilateral knees) Type 2 diabetes mellitus Atrial fibrillation Cataracts (bilateral pseudophakia)

Medications

apixaban (Eliquis®) 5 mg PO BD, perindopril (Coversyl®) 5 mg PO daily, metformin (Diabex®) 500 mg PO BD, paracetamol (Panadol Osteo®) 1,330 mg PO TDS, colecalciferol (Ostelin®) 25 mcg PO daily

Allergies

Penicillin (maculopapular rash)

Psychosocial History

Lives: Single-storey brick home with his wife, Margaret Children: 3, Grandchildren: 6 Born in: Glasgow, Scotland Emigrated to Australia in: 1968 Personal Activities of Daily Living: Independent with showering, dressing, and toileting Domestic ADLs: Assisted by wife for cooking, cleaning, and laundry Community ADLs: Daughter manages finances and online banking; wife manages shopping Current services in place: Local council domestic assistance fortnightly Driving: Holds unrestricted licence; drives locally during daytime only Falls in the last 12 months: 2, Mobility aid: Single-point stick outdoors, Fall circumstances: Tripped over rug indoors 3 months ago, and lost balance in the garden 4 weeks ago; no LOC or fractures Educational level: Completed Year 10 equivalent Employment History: Retired boilermaker EPOA completed: Yes (Wife and eldest daughter appointed) My Aged Care: Registered, awaiting ACAT assessment for Level 2 HCP Nonsmoker, EtOH: Ex-smoker (ceased 1995), 1–2 standard drinks of beer on weekends Vaccinations: Influenza (April 2024), COVID-19 booster (May 2024), Prevenar 13 (2021), Shingrix (completed 2023) FHx: Maternal history of Alzheimer's disease; father died of AMI aged 72 Exercise: 15-minute walk around the block 3 times per week

Background

Arthur presented today accompanied by his wife, Margaret, and daughter, Sarah, for a comprehensive geriatric assessment following a gradual decline in short-term memory over the past 18 months and two recent mechanical falls. Margaret reports that Arthur frequently repeats questions, misplaces household items, and has become increasingly reliant on her for daily prompting. There is no history of wandering, aggression, or visual hallucinations.

Regarding his falls, Arthur describes feeling unsteady when turning quickly or walking on uneven surfaces. He denies pre-syncopal symptoms, palpitations, or vertigo prior to falling. Review of his medications reveals long-term antihypertensive use, which may be contributing to postural instability.

Assessments

Arthur completed a Mini-Mental State Examination (MMSE) and a Geriatric Depression Scale (GDS-15) during today's consultation. On the MMSE, Arthur scored 23/30, losing points on delayed recall (0/3), orientation to time (3/5), and serial sevens (3/5), while visuospatial construction remained intact. His GDS-15 score was 2/15, indicating no significant depressive symptomatology. Timed Up and Go (TUG) test was prolonged at 16 seconds using his single-point stick.

Systems Review

Appetite: Fair, eating smaller portions than usual Weight: Lost 2 kg over the last 6 months Mood: Euthymic, occasionally frustrated by memory lapses Sleeping: 6–7 hours per night, wakes twice for nocturia Pain: Mild bilateral knee ache (3/10), controlled with paracetamol Aids used: Single-point stick outdoors, reading glasses, bilateral hearing aids Bowels: Regular, daily, normal consistency Bladder: Nocturia x2, occasional mild urgency, no incontinence Memory: Subjective decline in short-term recall; preserved long-term memory

Pathology

FBE normal, UEC eGFR 62 mL/min/1.73m2, LFTs normal, HbA1c 6.8 %, TSH 2.1 mIU/L, Vitamin B12 310 pmol/L, Folate 24.5 nmol/L, Vitamin D 78 nmol/L.

O/E

HR 68 bpm irregular, BP lying 138/78 mmHg, BP standing (1 min) 118/70 mmHg, symptomatic postural drop of 20 mmHg systolic with mild lightheadedness, normal tone, power 5/5 throughout upper and lower limbs, reduced vibration sense to ankles bilaterally, trace bilateral pitting pedal oedema, weight 74.5 kg, gait slow and mildly broad-based with reduced stride length and cautious turning.

Cognitive Assessment

Performed today; MMSE 23/30 and Clock Drawing Test 3/4 (minor spacing error), consistent with mild cognitive impairment vs early major neurocognitive disorder.

Issues Discussed During Consultation

• Cognitive decline: Discussed MMSE results showing short-term memory impairment; arranged non-contrast CT brain to exclude structural pathology and assess vascular burden.
• Recurrent falls and postural hypotension: Identified 20 mmHg systolic postural drop likely secondary to perindopril; decreased dose to mitigate fall risk.
• Driving safety: Discussed legal obligations regarding cognitive impairment and driving; advised restricting driving to local familiar routes pending formal occupational therapy driving assessment.
• Support services: Discussed escalating home support via My Aged Care and introducing a Webster-pak to ensure medication adherence.

Plan / Recommendations

• Reduce perindopril from 5 mg to 2.5 mg PO daily and monitor home BP sitting and standing for 2 weeks.
• Commence Webster-pak managed by community pharmacy with wife supervising administration.
• Complete non-contrast CT brain prior to next appointment.
• Refer to community physiotherapy and occupational therapy for home safety assessment, falls prevention program, and transition to a 4-wheeled walker.
• Follow up in 4 weeks to review CT brain results, BP log, and formalise diagnosis.