Assessment of the Older Adult Chapter objectives List the essential components of the comprehensive health assessment of the older adults Discuss the advantages of the use of standardized tools in the gerontological assessment Describe the purpose of the inclusion of functional assessment © Ma'en Aljezwi

Introduction Assessment of the older adults requires special abilities of the nurses: listen carefully, allow for pause, ask questions and to observe details Assessment for older adults takes more time than usual The assessment provides information critical to the development of a plan of care Periodic assessment allows the chance to compare with the baseline © Ma'en Aljezwi

Health history It may be written or orally Face-to-face or through a proxy (with consent) An interpreter may be needed It may take double the time if an interpreter is needed Using of questions related to the explanatory model (Kleinman,1980) © Ma'en Aljezwi

Components of health history for older adults Patient profile Past medical history Review of systems and symptoms Medication (prescribed, over the counter, herbal, dietary supplants) Reported functional status Social history (current living arrangements, economic status, amount of family or friends who can support and type of community resources) © Ma'en Aljezwi

Components of health history for older adults It includes who make health decisions Psychological parameters: Cognitive emotional wellbeing, caregiver stress self perception of health Patterns of health and health care © Ma'en Aljezwi

Components of health history for older adults Education Family structure Plans for retirement Sexual dysfunction Depression Alcoholism Hearing loss Memory loss or confusion © Ma'en Aljezwi

Explanatory model (Kleinman, 1980) © Ma'en Aljezwi

Physical assessment The examiner should be knowledgeable about the changes of age Two tools are used: … FANCAPES SPICES © Ma'en Aljezwi

FANCAPES Fluids: state of hydration, ability of the person to obtain fluids Aeration (adequacy of Oxygen exchange): respiratory rate and depth in rest and during activity, breath sounds, oxygen saturation if problems are suspected e.g. pneumonia Nutrition: amount and type of food consumed, ability to bite, chew, swallow, dentures, special diet, impairments that can hinder ability to eat or prepare food © Ma'en Aljezwi

FANCAPES Communication: sight and sound acuity, voice quality , function of tongue, ability to read and write, understand spoken language Activity: ability to ambulate, eat, toilet, groom, prepare meals, use telephone, moving with or without assistive devices Pain (mental & physical): presence of discomfort, symptoms of anxiety may identify pain, how a person attain relief from pain © Ma'en Aljezwi

FANCAPES Elimination: urinary dribbling or incontinence, use of diapers or devices to urinate, medications that affect voiding Social skills: ability to negotiate, give and receive love and friendship, feel self-worth © Ma'en Aljezwi

SPICES Sleep disorders Problem with eating Incontinence Confusion Evidence of falls Skin break-down © Ma'en Aljezwi

FANCAPES & SPICES Anything that indicates a problem in one of the categories warns the nurse that a more in-depth assessment is needed It is a system to alert the nurse to the most common problems that interfere with health © Ma'en Aljezwi

Functional assessment Evaluation of a person ability to carry out basic tasks for self-care and tasks to support independent living This type of assessment will help the nurse to: Identify areas in which help is need Identify changes in abilities from time to time The need for specific service Assessing the safety of a particular living situation © Ma'en Aljezwi

Functional assessment Numerous tools are available that describes, assess, screen and predict functional abilities referred to as Activities of Daily Livings (ADLs) Also tasks needed for independent living : instrumental activities of daily living (IADLs) The majority of tools do not break down tasks (e.g. eating into components like piking-up food, chewing, using spoon..) © Ma'en Aljezwi

Functional assessment staging (FAST) Stage Stage Name Characteristic Expected Untreated AD Duration (months) Mental Age (years) MMSE (score) 1 Normal Aging No deficits whatsoever -- Adult 29-30 2 Possible Mild Cognitive Impairment Subjective functional deficit 28-29 3 Mild Cognitive Impairment Objective functional deficit interferes with a person's most complex tasks 84 12+ 24-28 4 Mild Dementia IADLs become affected, such as bill paying, cooking, cleaning, traveling 24 8-12 19-20 5 Moderate Dementia Needs help selecting proper attire 18 5-7 15 6a Moderately Severe Dementia Needs help putting on clothes 4.8 9 6b Needs help bathing 8 6c Needs help toileting 6d Urinary incontinence 3.6 3-4 6e Fecal incontinence 9.6 2-3 7a Severe Dementia Speaks 5-6 words during day 12 1.25 7b Speaks only 1 word clearly 7c Can no longer walk 7d Can no longer sit up 0.5-0.8 7e Can no longer smile 0.2-0.4 7f Can no longer hold up head 0-0.2 © Ma'en Aljezwi

Activities of daily living Theses include: bathing, dressing, toileting, continence transferring (refers to ambulation as well), and feeding Two of these tasks(dressing and grooming) and bathing requires higher cognitive function than others Katz Index: has served as a basic framework for most measures of ADLs © Ma'en Aljezwi

© Ma'en Aljezwi

Screening assessment of cognition Mini-Mental State Examination: It is a 30-item instrument that is used to screen and monitor cognitive function It is useful for gross screening of dementia It tests orientation, short-term memory, attention, calculation © Ma'en Aljezwi

© Ma'en Aljezwi

© Ma'en Aljezwi

Screening assessment of cognition Clock drawing test: it can be used to screen for dementia, however it is used to test for executive function Some level of manual dexterity and visual acuity is required, so it is not suitable for blind or who have paralysis or arthritis © Ma'en Aljezwi

Clock drawing test © Ma'en Aljezwi

Mini-Cog Equivalent to the MMSE Less biased Easier to administer More sensitive to dementia It assesses short –term memory and executive functioning © Ma'en Aljezwi

© Ma'en Aljezwi ADMINISTRATION SPECIAL INSTRUCTIONS 1. Get patient’s attention and ask him or her to remember three unrelated words. Ask patient to repeat the words to ensure the learning was correct. Allow patient three tries, then go to next item. The following word lists have been v Version 1 Banana Sunrise Chair Version 2 Daughter Heaven Mountain alidated in a clinica Version 3 Village Kitchen Baby Version 4 River Nation Finger l study:1–3 Version 5 Captain Garden Picture Version 6 Leader Season Table 2. Ask patient to draw the face of a clock. After numbers are on the face, ask patient to draw hands to read 10 minutes after 11:00 (or 20 minutes after 8:00). Either a blank piece of paper or a preprinted circle (other side) may be used. A correct response is all numbers placed in approximately the correct positions AND the hands pointing to the 11 and 2 (or the 4 and 8). These two specific times are more sensitive than others. A clock should not be visible to the patient during this task. Refusal to draw a clock is scored abnormal. Move to next step if clock not complete within three minutes. 3. Ask the patient to recall the three words from Step 1. Ask the patient to recall the three words you stated in Step 1. © Ma'en Aljezwi

3 recalled words Negative for cognitive impairment 1-2 recalled words + normal CDT Negative for cognitive impairment 1-2 recalled words + abnormal CDT Positive for cognitive impairment 0 recalled words Positive for cognitive impairment © Ma'en Aljezwi

Assessment of mood Geriatric depression scale (GDS) 30-item tool developed specifically for screening older adults and has been extensively. Also there is a 15 and 5-item shortened versions It de-emphasizes physical complaints, libido, and appetite In short-version: no questions about suicide Other scales include: Center For Epidemiological Studies Depression Scale, Cornell Scale For Depression In Dementia © Ma'en Aljezwi

© Ma'en Aljezwi

Comprehensive geriatric assessment The minimum data set: used in the nursing home settings as a mean to not only plan and monitor care, but to describe the care in long-term care settings Includes measures of: pain, cognition, delirium, and depression Requires the use of other expert tools © Ma'en Aljezwi