1. Psychological Assessment
Chapter Sixteen
Psychological Assessment

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

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

15. 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?

16. 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

17. 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

18. 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

19. 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

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