1. 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
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2. 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
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3. 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)
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4. 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)
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5. 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
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6. Components of health history for older adults
Education
Family structure
Plans for retirement
Sexual dysfunction
Depression
Alcoholism
Hearing loss
Memory loss or confusion
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7. Explanatory model (Kleinman, 1980)
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8. Physical assessment
The examiner should be knowledgeable about the changes of age
Two tools are used: …
FANCAPES
SPICES
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9. 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
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10. 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
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11. 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
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12. SPICES Sleep disorders Problem with eating Incontinence Confusion
Evidence of falls
Skin break-down
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13. 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
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14. 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
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15. 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..)
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16. 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 7e
Can no longer smile 7f
Can no longer hold up head
0-0.2
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17. 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
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18. © Ma'en Aljezwi

19. 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
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21. © Ma'en Aljezwi

22. 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
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23. Clock drawing test
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24. Mini-Cog Equivalent to the MMSE Less biased Easier to administer
More sensitive to dementia
It assesses short –term memory and executive functioning
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25. © 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.
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26. 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
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27. 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
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28. © Ma'en Aljezwi

29. 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
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