Week 2 Notes: Assessment of Health and Functioning in Older Adults

Fall 2023 Week 2: Assessment of Health and Functioning

1. Older Adult Nursing Assessment

• Focus: Age-related changes, risk factors, and functional consequences, including:

  • Decreased physiologic function

  • Potential for psychosocial and spiritual growth

  • Vulnerability to risk factors

• Encompasses: Health and functioning, quality of life (QOL), diseases, stressors, environmental barriers, adverse drug effects, ageism, and lack of information.

• Nursing Interventions Aim: Produce wellness outcomes with positive functional consequences in activity and functioning, QOL, and overall health.

  • _Adapted from Miller, C. Nursing for Wellness in Older Adults, 7th edition, Wolters Kluwer, p. 136.

2. Functional Assessment

• Key Terminology:

  • Activities of Daily Living (ADLs)

  • Instrumental Activities of Daily Living (IADLs)

  • Psychological function

  • Social functioning

• Focus: Older adult’s ability to perform ADLs that affect survival and quality of life.

• Purpose: Provides a framework for research, a method of planning health services, and is important for promoting wellness outcomes.

3. Complexity of Health Assessment in Older Adults

• Contributing Factors:

  • One or more chronic conditions

  • Illnesses that present differently in older adults

  • Multiple factors

  • Comorbid medical conditions

  • Age-related changes

  • Adverse effects of medications or treatments

  • Psychological factors

  • Environmental factors

• Comorbid Conditions & Other Contributors:

  • Acute illness

  • Common issues: hip problems/fracture, stroke (left/right sided weakness)

  • Alterations in nutrition and/or hydration

  • Chronic illnesses: osteoarthritis (impairing mobility, bathing, transferring, toileting)

  • Pain

  • Delirium

  • Dementia

  • Economics

  • Environment

  • Medications

  • Psychiatric comorbidities (e.g., depression)

  • Psychological/social stressors

4. Physiologic Aging Changes

• Major Changes:

  • Reduced physiologic reserve (cardiac, respiratory, renal systems)

  • Reduced homeostatic mechanisms

  • Failure to adjust regulatory systems

  • Faulty temperature control

  • Fluid and electrolyte balance disturbances

  • Impaired immunologic function

  • Increased risk of infection and autoimmune diseases

5. Atypical Presentation in Older Adults

• Leads to missed pathology due to atypical signs and symptoms.

• Key Considerations:

  • Do not mistake normal aging for disease or disease for normal aging.

  • Clinicians must know how lab values differ for older patients.

• New Onset Signs and Symptoms:

  • Confusion (delirium) – $60\%$ of hospitalized frail older adults

  • Self-neglect

  • New onset falls

  • Incontinence

  • Apathy

  • Anorexia

  • Dyspnea

  • Fatigue

6. Functional Decline Characteristics and Statistics

• Chronic conditions increase with age (e.g., arthritis, hypertension, heart disease, hearing impairment, cataracts).

• Healthcare Utilization by Older Persons:

  • Approximately one-third of physician resource use

  • One-quarter of all medications prescribed

  • Two-fifths of hospital admissions

• Functional Deficits (NHIS, 2014):

  • Adults aged $\geq 75$ years most likely to require help:

    • ADLs ($10.6 ext{ extpercent}$)

    • IADLs ($18.8 ext{ extpercent}$)

• Disabilities Among Persons Aged 65 and Over (U.S. Census Bureau, American Community Survey, 2017):

  • Independent living difficulty: $14\%$

  • Self-care difficulty: $8\%$

  • Ambulatory difficulty: $22\%$

  • Cognitive difficulty: $9\%$

  • Vision difficulty: $6\%$

  • Hearing difficulty: $14\%$

  • Any disability: $35\%$

7. Functional Assessment Tools

• Katz Activities of Daily Living (ADL) Scale:

  • Bathing

  • Dressing

  • Toileting

  • Transferring

  • Continence

  • Feeding

• Lawton Instrumental Activities of Daily Living (IADL) Scale:

  • Ability to telephone

  • Shopping

  • Food preparation

  • Housekeeping

  • Laundry

  • Mode of transportation

  • Responsibility for own medication

  • Ability to handle finances

• Timed “Get-up and Go” Test:

  • Procedure: Rising from a chair, standing still momentarily, walking toward a wall, turning around, walking back to the chair, turning around again, and sitting down.

  • Used to evaluate safe discharge (e.g., Mr. Howell assessment).

• SPICES (Functional Assessment Tool):

  • Sleep disorders

  • Problems eating/feeding

  • Incontinence

  • Confusion

  • Evidence of falls

  • Skin breakdown

8. Nursing Interventions & Strategies for Optimal Functioning

• Nursing Interventions:

  • Multidisciplinary geriatric assessment framework.

  • Intense discharge planning in the hospital setting.

  • Exercise is beneficial for older adults.

  • Nutrition alone (supplements) is not beneficial.

  • Pain management: Stepped care approach following the WHO ladder.

• Strategies for Optimal Functioning:

  • Promote exercise and physical activity.

  • Design environments with features like handrails, wide doorways, and raised toilet seats.

  • Explore alternative living arrangements (e.g., ground floor for Mr. Howell to avoid stairs).

  • Practice judicious use of medications.

  • Implement regular cancer prevention and disease screening.

  • Consider alternatives to restraints to enhance safety and autonomy.