This Domain includes assessing our patients' mood and social support. An appreciation of how these aspects of their lives allows for a deeper understanding and care in their overall health.
Psychiatric: Mood disorders are common in later life and may cause loss of function. The PHQ2 may be used to screen for depression
- PHQ2: The Patient Health Questionnaire 2 asks 2 questions to screen for depression, and if positive, should be followed by the full PHQ9.
- Hallucinations: Asking if a patient has any auditory or visual hallucinations may help with diagnosis of delirium, Dementia (I.e. Lewy Body Dementia) and Schizophrenia.
Drugs and Sex: Often overlooked, but asking about any substance abuse (I.e. Alcohol, marijuana, etc) and sexual activities may lead to discovery of significant comorbidities. For example:
- High risk sexual behavior -> HIV or syphilis leading to Dementia
IV drug use -> hepatitis C, HIV, etc.
Elder abuse/neglect: Often overlooked, but as our aging population depends more and more on caregivers and family support, neglect, financial and physical abuse become more prevalent
Any encounters require mandatory reports to the State
Social support: The following are common living situations
- Home: This is the most common. Some individuals live alone or with family +/- caregiver
- Assisted living facility (ALF): Usually an apartment-style facility where individuals have varying degrees of independence. Generally, ALF's provide help with IADLs like cooking and cleaning.
- Board and Care (B&C): Similar services like Assisted living facilities, but usually in a home setting. A common scenario is 3-5 residents living in a house, cared for by 1-2 caregivers.
- Skilled nursing facility (SNF): These facilities provide skilled nursing needs, such as rehabilitation (PT/OT), IV antibiotics, wound care. Medicare will pay completely for the first 20 days and then 80% of the cost (~$144.50/day) for up to 80 days of a stay as long as there is a skilled need. If there is no longer a skilled need or the individual has reached “plateau” with therapy, the cost is usually out of pocket afterwards. The benefit period resets if there is a readmission for a different need or diagnosis after a 60-day break.
