Dimensions of the HEAT-GEROMAP and Their Guiding Questions

How is the Heat-GEROMAP Generated?

The heat map generation is simple, as it involves categorizing responses into three situational groups, identified by green, yellow, and red colors. Now, let's explore each dimension of the Heat-GEROMAP and its guiding questions.

DIMENSION 1 – CLINICAL

This dimension of the GEROMAP-Tool provides an overview of all previously diagnosed diseases in elderly patients, grouped into 10 major categories. For questions 1.1 to 1.9, the classification is as follows:

• Green: No diagnosed disease
• Yellow: At least one diagnosed disease
• Red: Two or more diagnosed diseases

Categories:

1.1 Cardiovascular Diseases, including hypertension and stroke
1.2 Endocrine Diseases, with a focus on diabetes
1.3 Autoimmune Diseases
1.4 Neurodegenerative and Psychiatric Disorders
1.5 Lung Diseases
1.6 History of Infectious and Parasitic Diseases with health impacts, such as tuberculosis, leishmaniasis, malaria, yellow fever, long COVID, etc.
1.7 Allergies
1.8 Urological Diseases in Men and Uro-Gynecological Diseases in Women
1.9 Cancer
1.10 History of Smoking and Alcohol Abuse

Classification for 1.10:

• Green: No condition
• Yellow: One condition
• Red: Both conditions

DIMENSION 2 – SPECIAL CARE NEEDS

It was observed that many instruments included questions that could have been answered if the patient's special care history had been known. For this reason, this dimension was incorporated into the Heat-GEROMAP.

Questions:

2.1 Use of a Wheelchair

• Green: No
• Yellow: In some situations (occasionally)
• Red: Always – In this case, it is recommended to mark questions 5.1 and 5.2 as red in the Nutrition dimension.

2.2 Use of Enteral Nutrition (feeding tube, gastrostomy)

• Green: No
• Yellow: Yes, with industrialized food
• Red: Yes, with homemade food – In this case, it is recommended to mark all Mobility dimension questions as red.

2.3 Presence of Pressure Ulcers or Chronic Wounds

• Green: No
• Yellow: No, but at high risk (e.g., diabetes, immobility)
• Red: Yes

2.4 Behavioral Changes that Hinder Relationships

• Green: No, or very rarely
• Yellow: Occasionally
• Red: Frequently

2.5 Chronic Pain/Fatigue

• Green: No, or very rarely
• Yellow: Occasionally
• Red: Frequently

DIMENSION 3 – SELF-CARE

Assessing the ability of elderly individuals to carry out daily living activities is essential for ensuring their well-being and autonomy.

Questions:

3.1 Self-Care: Requires help with dressing, bathing, hygiene, or eating.

• Green: No, or very rarely
• Yellow: Occasionally
• Red: Always

3.2 Urinary and/or Fecal Incontinence

• Green: No, or very rarely
• Yellow: Occasionally
• Red: Frequently

3.3 Self-Management: Needs help managing money, shopping, or paying bills.

• Green: No, or very rarely
• Yellow: Occasionally
• Red: Frequently

3.4 Vision Quality: Poor vision, even with glasses, interfering with activities.

• Green: No, or very rarely
• Yellow: In certain situations
• Red: Frequently

3.5 Hearing Quality: Poor hearing, even with hearing aids.

• Green: No, or very rarely
• Yellow: In certain situations
• Red: Frequently

DIMENSION 4 – PSYCHOCognition

Evaluating cognition and mood is essential, as changes can indicate psychiatric disorders, neurodegenerative diseases, or adverse medication effects.

Questions:

4.1 Self-Reported Memory Problems

• Green: No
• Yellow: In certain situations
• Red: Yes

4.2 Three-Word Recall:

• Green: Remembered all three
• Yellow: Remembered two
• Red: Remembered one or none

4.3 Feeling Anxious, Depressed, or Stressed

• Green: No
• Yellow: Yes, but due to specific issues
• Red: Yes, without an apparent cause

4.4 Appetite Changes

• Green: No
• Yellow: Sometimes
• Red: Yes

4.5 Sleep Changes

• Green: No, or very rarely
• Yellow: Sometimes
• Red: Yes

DIMENSION 5 – NUTRITION

Assessing nutritional indicators is essential, as they are associated with conditions such as sarcopenia, cachexia, and chronic diseases like obesity.

5.1 Body Mass Index (BMI, Kg/m²):

• Green: 22 to 27
• Yellow: 27 to 29.9
• Red: <22 or >30

5.2 Calf Circumference (cm):

• Green: ≥35 cm
• Yellow: 31 to 34 cm
• Red: <31 cm

DIMENSION 6 – MOBILITY

Assessing mobility is essential for maintaining cardiorespiratory function and preventing falls and fractures.

Questions:

6.1 Can the Patient Raise Their Arms Above Their Shoulders?

• Green: Yes
• Yellow: Depends on the situation
• Red: No

6.2 Can the Elderly Man Hold 2 kg and the Woman 1 kg for 1 Minute?

• Green: Managed with both arms
• Yellow: Managed with one arm
• Red: Could not manage with either arm

6.3 Timed Up and Go Test

• Green: <14 seconds
• Yellow: 15 to 20 seconds
• Red: >20 seconds

6.4 Falls or Home Accidents in the Past 6 Months

• Green: No
• Yellow: Yes, without fractures
• Red: Yes, with fractures

6.5 Fine Motor Coordination:
Place a 1 BRL coin on a flat surface. Instruct the patient to pick it up after counting 1, 2, 3, and time the attempt for 1 minute.

• Green: ≤30 seconds
• Yellow: 31 to 60 seconds
• Red: >60 seconds

DIMENSION 7 – MEDICATION AND POLYPHARMACY

Detecting polypharmacy and the use of potentially inappropriate medications (PIMs) is essential to avoid harmful interactions and optimize treatments.

Questions:

7.1 Polypharmacy (Regular Use):

• Green: None or one medication per day
• Yellow: 2 to 4 medications per day
• Red: 5 or more medications per day

7.2 PIMs with Effects on the CNS (e.g., ataxia, cognitive decline, mood changes, dizziness, psychosis):

• Green: None
• Yellow: At least one
• Red: Two or more

7.3 PIMs with Cardiovascular, Renal, or Stroke Risks:

• Green: None
• Yellow: At least one
• Red: Two or more

7.4 PIMs with Digestive System Effects (e.g., constipation, diarrhea, nausea, reflux, heartburn):

• Green: None
• Yellow: At least one
• Red: Two or more

7.5 PIMs Increasing Risk of Falls, Fractures, and Osteoporosis:

• Green: None
• Yellow: At least one
• Red: Two or more