Geriatric Care and the GEMS Diamond

The aging process is often misunderstood. Many clinicians are fantastic at working with older populations while others find it quite challenging. When working with older populations, the GEMS diamond assessment system is a simple way to recall elements key to working with older demographic groups. Most importantly, it’s essential to remember older patients have the same thoughts, ideals, and motivations as their younger cohorts. They enjoy independence, freedom, and autonomy. Treating them as children is one of the greatest mistakes any practitioner can make.

The GEMS Diamond is a simple way to remember the following four points when assessing an older patient:

◾G – Recognize the patient is a geriatric patient and keep in mind they often present atypically. Remember geriatric patients deserve respect (as with all patients), and anticipate the presence of normal changes that occur with the natural aging process.

◾E – Environmental Assessment. Take a quick look at the patient’s home or surroundings. Is the home well kept or is it cluttered and dirty. Is there adequate heat present? Is the exterior of the home in need of repairs? Is the home safe and secure? Take a quick look around for hazards that may present themselves like unventilated oil and gas heaters, broken windows and glass, excessive clutter. Does the place smell like feces, urine, or rotten food? If there are pets do they look like they’re well taken care of? Is the place riddled with empty liquor bottles (remember, alcohol is the number one drug of abuse in geriatric populations). Are there medication bottles laying around and are these out of date (keep in mind, poly-pharmacy and drug interactions are a major concern for older patients). If the patient has a caregiver or is residing in a nursing facility, does the care appear to be adequate for the patient’s needs? Is the patient sequestered to only one part of the home? Watch for signs of elder abuse.

◾M – Medical Assessment. Most geriatric patients have a myriad of health concerns which makes assessing them intrinsically more complex. Often times chronic ailments mask acute signs and symptoms, so vigilance on the part of the practitioner is essential. Getting a solid medical history from all geriatric patients is essential, regardless of their chief complaint.

◾S – Social Assessment. Does the patient have a social network? Humans are social beings and being social is important to our health, wellness, and survival. Lack of social interaction often leads to depression which is more common than you think in geriatric populations. Look at things like how the patient is toileting, dressing, bathing, and eating? Is the patient able to take care of themselves and if not, are they being adequately taken care of by their caregiver? Is the patient getting enough food? Do they have regular access to food and bathing? Ask the patient and also do a critical assessment.

Geriatric patients have special needs that must be managed in a mindful and graceful way. If you approach them with an attitude of patience, caring, and compassion you’ll be well on your way to making a profound positive impact in their health, welfare, and lives.

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