Psychological Assessment Chapter Sixteen Psychological Assessment

Psychological Assessments Important for evaluating the mental health of older adults Need to identify psychological areas of decline and recognize appropriate interventions Assessment tools provide a brief methodological approach for noting changes

Mental Health Absence of mental disease Mental health wellness includes Clear meaning and purpose in life Strong reality orientation Ability to cope with life’s situations Capable of maintaining open, creative relationships

Cognition Mental activity that involves processing information Complex and involves several abilities or functions Memory Active individuals have better memory Decrease in memory is symptom of most cognitive disorders common in older adults

Cognition Memory (cont.) Perception Memory is important to a person’s ability to think Short term memory measured in seconds Long term memory measured in minutes and longer Perception One’s awareness of environment Nurses need to understand the perceptual world of their patients

Cognition Perception (cont.) Perception has an emotional component Normally evaluated based on past experiences Perceptional distortions also known as hallucinations and delusional thinking

Cognition Orientation Person’s awareness of self in the context of a particular time and place Assess orientation for person, place, and time Poor orientation is symptom of brain disease

Cognition Thinking Higher level Lower level Form concepts and think in an abstract manner More fragile Lower level Concrete thoughts More enduring Less effected by brain injury

Cognition Communicating Calculating Human thoughts reflected in language Language problems common in cerebrovascular and dementing disorders Calculating Assessed in relationship to person’s education level and intelligence

Cognition Problem solving Problem-solving skills are essential for a person to function in any environment

Assessment Tools Mental status examinations Most commonly used for psychological assessment Assess for cognitive ability as well as level of consciousness Brief assessment tools are easier to use with older adults

Assessment Tools Easy tools to use Mini Mental Status Exam (MMSE) Short Portable Mental Status Questionnaire (SPMSQ) Mental Status Questionnaire (MSQ) Cognitive Capacity Screening Exam (CCSE) Test results influenced by educational level of person being tested

Assessment Tools Initial tests provide a baseline for comparison of changes over time Assessment of memory includes reception, storage, and retrieval Assessment for orientation includes time, place, and person

Assessment Tools Assessment of level of orientation includes four levels Alert Lethargy Stuporous Comatose

Assessment Tools Delirium is assessed by recognizing changes in levels of consciousness and levels of orientation Validity Does the question really measure what is being tested? Reliability Will two nurses get the same response from a patient?

Assessment Tools Assess an individual Assessment techniques On admission When acute changes occur Assessment techniques Timing Allow person to select the appropriate time Privacy Ensure confidentiality

Assessment Tools Assessment technique (cont.) Assessment results Eliminate interruptions May have affect on reliability and validity of results Positively introduce assessment tool Assessment results Use to patient’s benefit Make information accessible

Applications in Clinical Practice Use for unit assignment for new admission Identify person’s strengths and weaknesses Use as basis for care planning Broad determination of the effects of an intervention Assist with diagnosis Monitor improvement or decline

Other Assessments Assessing depression Assessing pain Depression is prevalent in older adults May predict the onset of a disability Assessing pain Chronic pain may impact persons ability to rehabilitate Behavioral problems may stem from pain

Other Assessments Assessing pain Barriers to assessing pain include cognitive impairments, delirium, dementia Methods of assessing Visual observation Assessment questions Pain scales