Chapter 7 Health Assessment Copyright © 2016 by Elsevier, Inc. All rights reserved.

Assessment of the Older Adult Is more complex May require a team of professionals Special skills for older adult assessment: Listen patiently Allow for pauses Ask questions that are not often asked Observe for minute details Use all available sources for data Recognize normal changes of aging from abnormal Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health History Includes: Demographic information Past medical history Current medications and dietary supplements Prescribed, over the counter, home remedies, herbals Social history Functional history Review of systems (ROS) Copyright © 2016 by Elsevier, Inc. All rights reserved.

Health History (Cont.) Factors influencing the collection of the health history (Box 7-1): Visual and auditory acuity Manual dexterity Language and health fluency Adequacy of translation materials Availability of a trained interpreter Cognitive ability and reading level Copyright © 2016 by Elsevier, Inc. All rights reserved.

Review of Systems Conducted prior to the physical examination Complex and time consuming Because of the number of health problems, one system often affects another system More like a “review of symptoms” See Box 7-2 for best practice tips when conducting a review of systems with an older adult Copyright © 2016 by Elsevier, Inc. All rights reserved.

Physical Assessment May be difficult to complete in one setting, depending on the patient’s stamina Not like the assessment process of a younger person Physical and cognitive limitations may affect the ability to perform the assessment Considerations of common changes specific to late life assessment (Box 7-4) Be aware of cultural rules of etiquette and taboos that influence physical assessment (Box 7-8) Copyright © 2016 by Elsevier, Inc. All rights reserved.

Physical Assessment Tools FANCAPES Fluids Aeration Nutrition Communication Activity Pain Elimination Socialization and social skills Fulmer SPICES Sleep disorders Problems eating Incontinence Confusion Evidence of falls Skin breakdown Copyright © 2016 by Elsevier, Inc. All rights reserved.

Physical Assessment Functional Assessment Evaluation of person’s ability to carry out basic tasks for self-care and tasks needed to support independent living Identifies specific areas of help Identifying changes in abilities from one time to another Provides information useful for assessing safety Numerous tools available that describe, screen, assess, monitor, and predict functional ability Copyright © 2016 by Elsevier, Inc. All rights reserved.

Physical Assessment (Cont.) Activities of Daily Living (ADLs) Katz Index Barthel Index Functional Independence Measure These tools provide caregivers with a common language and therefore have the potential to increase quality of care Copyright © 2016 by Elsevier, Inc. All rights reserved.

Physical Assessment (Cont.) Functional Independence Measures Assesses three levels of functioning Independent Assisted Unable to perform Copyright © 2016 by Elsevier, Inc. All rights reserved.

Functional Assessment Staging (FAST) tool Stage 1 -- Normal adult No functional decline. Stage 2 -- Normal older adult Personal awareness of some functional decline. Stage 3 -- Early Alzheimer's disease Noticeable deficits in demanding job situations. Stage 4 -- Mild Alzheimer's Requires assistance in complicated tasks such as handling finances, planning parties, etc. Stage 5 -- Moderate Alzheimer's Requires assistance in choosing proper attire. Stage 6 -- Moderately severe Alzheimer's Requires assistance dressing, bathing, and toileting. Experiences urinary and fecal incontinence. Stage 7 -- Severe Alzheimer's Speech ability declines to about a half-dozen intelligible words. Progressive loss of abilities to walk, sit up, smile, and hold head up. Copyright © 2016 by Elsevier, Inc. All rights reserved. From Reisberg, B: Functional Assessment Staging (FAST), Psychopharmacol Bull 24:653–659, 1998. Copyright © 1984 by Barry Reisberg, M.D. Reproduced with permission.

Physical Assessment Function and Cognition Blessed Dementia Scale Used when assessing both function and cognition 22 items Incorporates ADLs, instrumental activities of daily living (IADLs), memory recall, and finding one’s way outdoors Copyright © 2016 by Elsevier, Inc. All rights reserved.

Mental Status Assessment Cognitive Measures Mini-Mental State Examination (MMSE) Clock Drawing Test Mini-Cog Global Deterioration Scale Copyright © 2016 by Elsevier, Inc. All rights reserved.

Mental Status Assessment (Cont.) Assessment of Mood Geriatric Depression Scale Cornell Scale for Depression in Dementia Copyright © 2016 by Elsevier, Inc. All rights reserved.

Comprehensive Geriatric Assessment Integrated approach Combines physical, functional, and psychosocial components into one instrument Generally comprehensive and lengthy Provides a basis for a detailed plan of care Copyright © 2016 by Elsevier, Inc. All rights reserved.

Comprehensive Geriatric Assessment (Cont.) Older Americans Resources and Services: Multidimensional Functional Assessment Questionnaire Social resources Economic resources Mental health Physical health ADL and IADLs Copyright © 2016 by Elsevier, Inc. All rights reserved.

Comprehensive Geriatric Assessment (Cont.) Resident Assessment Instrument Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid Quality Indicators (Box 7-15) Incorporates 450-item Minimum Data Set Copyright © 2016 by Elsevier, Inc. All rights reserved.

Comprehensive Geriatric Assessment (Cont.) Outcomes and Assessment Information Set (OASIS C1) Identifies the plan for nursing care in the home Aimed at preventing rehospitalizations and ensuring safety in the home setting Risk for hospitalization (Box 7-17) Copyright © 2016 by Elsevier, Inc. All rights reserved.

Implications for Gerontological Nursing Goal of assessment is always to assist the person to move along the wellness trajectory toward health aging, regardless of care setting or health status The gerontological nurse is challenged to provide the highest level of excellence in assessment of elderly without burdening the person in the process Copyright © 2016 by Elsevier, Inc. All rights reserved.

Question 1 The FAST tool is an assessment tool to gauge: ADLs. Alzheimer’s. depression. mood. ANS: B Copyright © 2016 by Elsevier, Inc. All rights reserved.

Question 2 Dressing, bathing, toileting, and feeding are examples of what? Functional markers IADLs Cognitive markers ADLs ANS: D Copyright © 2016 by Elsevier, Inc. All rights reserved.