1. Chapter 7 Health Assessment
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2. 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
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3. 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)
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4. 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
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5. 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
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6. 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)
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7. 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
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8. 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
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9. 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
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10. Physical Assessment (Cont.)
Functional Independence Measures
Assesses three levels of functioning
Independent
Assisted
Unable to perform
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11. 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.
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From Reisberg, B: Functional Assessment Staging (FAST), Psychopharmacol Bull 24:653–659, Copyright © 1984 by Barry Reisberg, M.D. Reproduced with permission.

12. 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
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13. Mental Status Assessment
Cognitive Measures
Mini-Mental State Examination (MMSE)
Clock Drawing Test
Mini-Cog
Global Deterioration Scale
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14. Mental Status Assessment (Cont.)
Assessment of Mood
Geriatric Depression Scale
Cornell Scale for Depression in Dementia
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15. 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
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16. Comprehensive Geriatric Assessment (Cont.)
Older Americans Resources and Services: Multidimensional Functional Assessment Questionnaire
Social resources
Economic resources
Mental health
Physical health
ADL and IADLs
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17. 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
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18. 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)
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19. 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
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20. Question 1 The FAST tool is an assessment tool to gauge: ADLs.
Alzheimer’s.
depression.
mood.
ANS: B
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21. Question 2
Dressing, bathing, toileting, and feeding are examples of what?
Functional markers
IADLs
Cognitive markers
ADLs
ANS: D
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