WEEK 3

Individualized Assessment of Older Adults

Assessment should be individualized and should not simply be a shortened assessment used for younger adults.

Health conditions, functional and cognitive abilities, lifestyle and social support, nutrition and medications, living environment, culture, goals, and preferences.

Factors That May Differ Among Older Adults of the Same Age

Starting With the Person’s Baseline

Determine what is normal for THIS patient before identifying changes.

■ Activity and mobility

■ Cognitive and communication status

■ Appetite and sleep

■ Bowel and bladder function

■ Mood and social activities

■ Ability to perform daily activities

Assess the older adult’s usual:

Importance of Baseline Changes

Subtle changes from an older adult’s baseline may indicate significant illness.

Normal Aging vs. Illness

○ Distinguish normal aging from disease or pathology

○ New, sudden, or progressive changes should not automatically be attributed to aging

○ Older adults of the same age may have very different nursing needs

■ Mobility

■ Strength

■ Pain

■ Sensory function

■ Chronic diseases

■ Acute illness

Physical Condition ○ Assess:

Hearing and vision problems can affect the accuracy of assessment.

Determine whether the patient:

■ Hears normal conversation

■ Uses hearing aids or glasses

■ Can see printed material

■ Needs better lighting or another information format

Sensory Abilities in Assessment

Face the patient, reduce background noise, speak clearly and slightly slower, do not shout, and verify understanding.

Communication With a Hearing-Impaired Older Adult

Assess nutrition and hydration, skin condition, elimination, sleep, and cognitive status.

Other Factors in Older Adult Assessment

Determine what brought the patient to the healthcare setting, when the problem began, what makes it better or worse, and whether it happened before.

Present Health Concern ask:

previous illnesses, surgeries, hospitalizations, injuries, chronic conditions, allergies, and immunizations.

Past Health History Assess

prescription and over-the-counter medications, herbal products, vitamins, supplements, medication adherence, and ability to obtain and correctly take medications.

Medication History Assess

Comprehensive Geriatric Assessment (CGA)

The purpose is to provide a structured, multidimensional, and interdisciplinary evaluation of older, often frail, individuals.

- It aims to identify their comprehensive medical, functional, psychological, and social needs

Functional Status

A significant component of an older adult’s quality of life that reflects the person’s ability to perform activities.

Activities of Daily Living (ADLs)

Basic self-care tasks such as bathing, dressing, eating, toileting, and mobility.

Instrumental Activities of Daily Living (IADLs)

More complex activities required for independent living.

Purpose of Functional Status Assessment

To identify abilities and limitations and guide appropriate interventions.

Timing of Functional Assessment

The client’s situation determines when, where, and how often assessment tools should be administered for accurate results.

Katz Index

A tool used to describe the client’s functional level by assessing whether patients can take care of themselves.

Cognitive Assessment

Assessment of level of consciousness, orientation to o person, place, time, and situation., attention, concentration, memory (immediate,recent,remote), language, thought processes, judgment, insight, executive function, reasoning, ability to follow instructions, behavior, mood, and changes from baseline.

Mini-Mental State Examination (MMSE)

A tool used to assess mental status, including orientation, registration, attention, calculation, recall, language, and visuospatial ability. Helps identify cognitive impairment and monitor changes.

Montreal Cognitive Assessment (MoCA)

A cognitive screening tool that is more sensitive to mild cognitive impairment. Assesses executive function, visuospatial skills, attention, memory, language, and orientation.

Mini-Cog

A quick cognitive screening tool that combines three-word recall and clock drawing.

Clock Drawing Test

A quick screening tools as combining three-word recall and clock drawing.

Confusion Assessment Method (CAM)

A tool mainly used to identify delirium rather than chronic dementia.

Physical Activity Readiness Questionnaire (PAR-Q)

A short screening questionnaire used to determine whether a person should seek medical advice before starting or increasing physical activity or exercise.

Mini Nutritional Assessment (MNA)

A tool used to evaluate nutritional status in older adults.

Some older adults may have difficulty changing position.

Positioning During Physical Assessment

Allow enough time for transfers.

Mobility During Physical Assessment

Thermoregulation may be altered.

Temperature Considerations in Older Adults

Assess pain rather than assume its presence or absence.

Pain Assessment in Older Adults

Check carefully for changes and risk of pressure injury.

Skin Assessment in Older Adults

Adjust lighting, communication, and equipment according to sensory needs.

Sensory Function During Physical Assessment

Avoid unnecessarily exhausting the older adult.

Fatigue During Assessment

Assess family relationships, caregivers, social support, living arrangements, financial resources, transportation, healthcare access, community resources, social isolation, and cultural factors.

Social Assessment

A medically stable older adult may still be unable to follow treatment because of lack of transportation, unaffordable medications, living alone, no caregiver, lack of food, or difficulty reading medication instructions.

Barriers to Following Treatment

Assess fall hazards, poor lighting, loose rugs, stairs, bathroom safety, accessibility, heating and cooling, medication storage, food availability, and transportation, The home environment may need to be assessed because it directly affects safety and independence

Environmental Assessment

Consider cultural beliefs, health and dietary practices, family roles, communication preferences, beliefs about illness, traditional remedies, decision-making preferences, and religious or spiritual practices. Avoid assuming that all older adults from the same cultural group share the same beliefs, Provide culturally congruent care

Cultural Considerations

Privacy and Autonomy

Protect the older adult’s privacy, dignity, confidentiality, autonomy, and right to participate in decisions.

Family Presence During Assessment

A family member’s presence does not mean that the family member should answer all questions.

Physical Problem and Psychosocial Effects: Arthritis

may cause difficulty walking, reduced social activity, and isolation.

Hearing Loss and Psychosocial Effects

communication difficulty, withdrawal, and loneliness.

Chronic Pain and Psychosocial Effects

decrease activity and contribute to depression or anxiety.

Stroke and Psychosocial Effects

loss of independence and decreased self-esteem.

Vision Impairment and Psychosocial Effects

cause fear of falling and avoidance of activities.

Depression and Physical Effects

decrease motivation to exercise or eat properly, leading to functional decline.

Social Isolation and Physical Effects

reduce support with medications and healthcare, resulting in poorer health outcomes.

Acute Disease

A disease that is sudden and short-term.

Chronic Disease

A disease that is long-term and requires ongoing management.

Congenital Disease

A disease present at birth.

Communicable Disease

A disease that can be transmitted.

Non-communicable Disease

A disease that is not transmissible.

Progressive Disease

A disease that worsens over time.

Stable Disease

A disease that remains relatively unchanged.

Episodic Disease

A disease or condition that occurs in episodes.

Disability

Limitations in activities or participation due to an impairment or health condition.

Physical function, sensory function, cognitive function, communication, psychological function, and social participation.

Areas Affected by Disability

Normal Aging vs. Disease

Do not automatically attribute new or significant changes to old age.

Multiple Health Problems

Chronic conditions may interact and complicate assessment.

Functional Status Consideration

Determine what the older adult can actually do.

Sensory Changes and Assessment

Vision or hearing loss may appear as confusion or withdrawal.

Cognitive Changes in Older Adults

Distinguish normal aging from delirium, dementia, depression, and other conditions.

Medication Effects

Polypharmacy increases the risk for adverse effects and drug interactions.

Communication Considerations

Allow time, use clear language, and consider sensory limitations.

Psychosocial Factors in Assessment

Consider relationships, finances, support, culture, and healthcare access.

Environmental Factors in Assessment

Housing, transportation, safety, and community resources affect independence.

Culture in Older Adult Assessment

Avoid assumptions and provide culturally appropriate care.

Individual Nature of Aging

Aging is highly individual.

Older adults may differ greatly in physical, cognitive, emotional, and social functioning.

Functional Differences Among Older Adults of the Same Age

individual older adult, baseline functioning, and changes from usual status.

Focus of Older Adult Assessment

Gordon’s 11 Basic Functional Health Patterns

A framework used to assess major functional health patterns of older adults.

Self-Perception/Self-Concept Pattern

Encompasses personal identity, body language, attitudes, and views of self in cognitive, physical, and affective realms.

● Includes expressions of self-worth and emotional state

Roles/Relationships Pattern

Encompasses achievement of expected developmental tasks and examines communication, interaction, meaningful communication, and satisfaction in relationships.

Health Perception/Health Management Pattern

Encompasses perceived level of health and current management of health problems.

Nutritional/Metabolic Pattern

Encompasses evaluation of dietary and other nutrition-related indicators.

Coping/Stress-Tolerance Pattern

Encompasses the client’s reserve and capacity to resist challenges to self-integrity, including the ability to manage difficult situations.

Cognitive/Perceptual Pattern

Encompasses self-management of pain, communication difficulties, and deficits in sensory function.

Value/Belief Pattern

Encompasses elements of spiritual well-being that older adults consider important for satisfactory daily living.

● Includes the philosophic system that helps the older adult function within society

Activity/Exercise Pattern

Encompasses information related to health promotion and encourages recommended 30 minutes of daily physical activity on most days of the week.

Rest and Sleep Pattern

Encompasses sleep and rest patterns over a 24-hour period and their effects on function.

Sexuality/Reproductive Pattern

Encompasses the older adult’s behavioral expressions of sexuality.

Elimination Pattern

Encompasses bowel and bladder excretory functions.

Explore personal ideas and beliefs about health needs, read current literature on health promotion, review current health policy information that safeguards client rights, and understand and use behavior change theories.

Planning for Older Adult Wellness

● Adopt a proactive stance toward an action plan for health promotion of the older individual

● Identify activities, locations, and means of disseminating health promotion

● Conduct annual health promotion screening

● Provide programs for vaccinations for older adults

● Conduct screening for cancer, diabetes, and other conditions

● Provide monthly health talks in senior centers

● Utilize housing sites and continuing retirement communities

● Advocate and educate about health promotion

● Promote safe medication use

Implementation of Wellness Care

Determine the effectiveness of the care plan and check established goals.

● Establish appropriate and realistic revised goals and realistic steps to achieve them

Evaluation of Wellness Care