2013 Hospice Workshop Handout - Revised 07/29/2013… · Recall 3 objects: orange ... (AMC) Male 23–25 cm 16–23 cm ... 2013 Hospice Workshop Handout - Revised 07/29/2013 Author:

Appendix

Schematic – Conceptual Representation of Clinical Conditions Mini Nutritional Assessment (MNA®) BMI Score Weight Loss Score Estimating Height From Ulna Length Estimating BMI Category From Mld Upper Arm Circumference (MUAC) Mini-Mental State Examination Evaluation of the Older Adult Who is Failing in the Community Anthropometric Measurements Documentation Tips Failure to Thrive Am Fam Physician Workshop Question Form

2013 Hospice Workshop Series

July 2013 Palmetto GBA - J11 Medicare Administrative Contractor (MAC) 1



Schematic – Conceptual Representation of Clinical Conditions 2013 Hospice Workshop Series
















Mini-Mental State Examination

( ) 1. What is the year ______, season ______, date ______, day ______, month ______. ( ) 2. What are we: state ______, county ______, town ______, hospital ______, floor ______. ( ) 3. Name 3 objects: orange ______, airplane ______, tobacco ______. (trails ______). ( ) 4. Serial 7's: ______ ______ ______ ______ ______ (93) (86) (79) (72) (65) or spell "world" backwards ____ ____ ____ ____ ____ (d) (l) (r) (o) (w) ( ) 5. Recall 3 objects: orange ______, airplane ______, tobacco ______. ( ) 6. Name a pencil ______, and watch ______. ( ) 7. Read and obey ______ CLOSE YOUR EYES

( ) 8. Copy design ______ (below) ( ) 9. Write a sentence ______ (below). ( ) 10. Repeat the following "no ifs, ands, or buts" ______. ( ) 11. Follow a 3-stage command: a: take a paper in your right hand ______ b. fold it in half ______ c. put it on the floor ______ Level of consciousness ______________________________________ (check) alert drowsy stupor coma Total (One point for each blank, maximum = 30) signature _______________________ Date Physician _________________



Evaluation of the Older Adult Who is Failing in the Community

Sarkisian, C.A. et. Al. Ann Intern Med 1996; 124:1072-1078



Anthropometric Measurements

Test Gender Normal values

Values showing malnutrition

Triceps skinfold (TSF) Male 11–12.5 mm 7.5–11 mm

Female 15–16.5 mm 10–15 mm

Mid upper arm circumference (MUAC Male 26–29 cm 20–26 cm

Female 26–28.5 cm 20–26 cm

Arm muscle circumference (AMC) Male 23–25 cm 16–23 cm

Female 20–23 cm 14–20 cm

AMC = MUAC – 0.314 = TSF

Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier





Documentation Tips



Robertson RG, Montagnini M. Geriatric Failure to Thrive. Am Fam Physician 2004;70:343-50.



http://www.aafp.org/afp/20040715/343.pdf






Question Contact Form

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Disclaimer: This form is for use in conveying general questions only and may not contain information that is privileged and confidential, specifically Protected Health Information (PHI). If you have a question about a specific claim, please request a call for follow up. Thank you. Revision #1 Revision date 08-02-2006 MR-QSF-7.5.1 LPET – Question Contact Form



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2013 Hospice Workshop Handout - Revised 07/29/2013… · Recall 3 objects: orange ... (AMC) Male 23–25 cm 16–23 cm ... 2013 Hospice Workshop Handout - Revised 07/29/2013 Author: