Assessment of the Older Adult:

Name: Assessment of the Older Adult:
Uploaded: 2017-07-09T03:05:17+00:00
Duration: PTM30S5
Channel: Aubrey Newman
Description: Assessment of the Older Adult:

Assessment of the Older Adult:
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Assessment of the Older Adult: Utilizing Standardized Tools for Recreational Therapy Treatment With Geriatric Clients Jo Lewis, MS/CTRS Megan Janke, Ph.D., LRT/CTRS

Assessing the Geriatric Client: Tools for Recreational Therapy
4/8/10 Objectives Upon successful completion of this session, the participant will be able to: Identify 3 standardized assessment tools that may be utilized in Recreational Therapy treatment with older adults. Verbalize 2 benefits of utilizing standardized assessments during Recreational Therapy treatment Utilize internet resources for standardized assessment tools in Recreational Therapy practice with older adults.

Key Concepts For Assessments
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Key Concepts For Assessments Validity Does it measure what it is intended to measure? External Internal Reliability Does it consistently measure what is intended? Internal Consistency Inter-rater Reliability Responsiveness Can it detect real change when it happens?

Why Use Standardized Assessments?
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Why Use Standardized Assessments? Measure what you intend to measure Justification of Services Accepted across discipline boundaries

4/8/10 Cognitive Scales Brief Interview for Mental Status Short Portable Mental Status Questionnaire Blessed Orientation-Memory-Concentration Test Global Deterioration Scale Brief Cognitive Rating Scale Clock Drawing Test Montreal Cognitive Assessment (MoCA) Iowa Geriatric Education Center Hartford Try This Series

Brief Interview for Mental Status
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Brief Interview for Mental Status Utilized for the MDS 3.0 Areas measured: attention orientation the ability to register and recall new information Maximum Score: 15 Cognitively intact 8-12 Moderate impairment 0-7 Severe impairment When developing the MDS 3.0, the BIMS was compared with the Cognitive Performance Scale and the Modified Mental Status Exam. It was found to be more accurate than the CPS. Average time for completion was 3.2 minutes. “The BIMS was attempted and completed in 90% of the 3258 residents in the feasiblity sample. BIMS scores covered the full instrument range (0-15). In the validation sample, correlation with the criterion measure (3MS) was higher for BIMS (0.906, P < .0001) than for CPS (-0.739, P < .0001); P < .01 for difference. For identifying any impairment, a BIMS score of 12 had sensitivity = 0.83 and specificity = 0.91; for severe impairment, a BIMS score of 7 had sensitivity = 0.83 and specificity = The area under the receiver operator characteristics curve, a measure of test accuracy, was higher for BIMS than for CPS for identifying any impairment (AUC = and 0.824, respectively) and for identifying severe impairment (AUC = and 0.857, respectively). Eighty-eight percent of survey respondents reported that the BIMS provided new insight into residents' cognitive abilities. The average time for completing the BIMS was 3.2 minutes.”

4/8/10

Short Portable Mental Status Questionnaire (SPMSQ)
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Short Portable Mental Status Questionnaire (SPMSQ) 10 Items Maximum Score: 10 0-2 errors Intact 3-4 errors Mild impairment 5-7 errors Moderate impairment 8-10 errors Severe impairment 5-10 minutes to administer Originally developed to map 4 levels of functioning, in practice it does not differentiate between those who are mildly impaired and those who are intact or those with moderate impairments. Allowances: Allow one more error if education does not go beyond grade school Allow one fewer error if education is beyond high school.

4/8/10

Blessed Orientation-Memory-Concentration Test
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Blessed Orientation-Memory-Concentration Test Domains assessed Orientation Immediate and delayed episodic recall Working memory 6 Items Maximum Score- 28 Higher score indicates greater impairment 3-6 minutes to administer Takes 3-6 minutes to administer All verbal items Dementia cut-off score is 10. Shows good sensitivity and test-retest reliability and convergent validity with other mental status tests are good. Drawbacks- relies on verbal skills- CVA or other conditions may affect ability to complete

Global Deterioration Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Global Deterioration Scale Rating scale 1: No cognitive impairment 2: Very mild cognitive decline 3: Mild cognitive decline 4: Moderate cognitive decline 5: Moderately severe cognitive decline 6: Severe cognitive decline 7: Very severe cognitive decline Used with Brief Cognitive Rating Scale The rating scale goes from 1 to 7 with higher numbers indicative of greater degrees of impairment. Does not require an individual to use physical abilities to complete the assessment, it does not evaluate decision-making ability. It also relies on verbal abilities to express information – orientation, recent memory, past memory. Now as far as standardization of this tool, it has been found correlate well with the MMSE, but there is no information about reliability available.

Brief Cognitive Rating Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Brief Cognitive Rating Scale 5 Axes Concentration Recent Memory Past Memory Orientation ADL & Functional Abilities Each axis is measured on a scale of 1-7 Scores from each axis added then divided by 5 Higher scores indicate higher level of impairment

4/8/10 Clock Drawing Test Correlates well with other cognitive assessment instruments Visuospatial Assessment of Cognitive Functioning 6 point scoring system The higher the score, the greater the degree of impairment Score of 3 or more indicative of cognitive loss Completed in about 5 minutes Screening tool 5 minutes to administer Drawbacks -reliance on dexterity and physical ability. -lacks sensitivity for mild cognitive impairment. -is not used as a staging assessment. Steps: Step 1: Give patient a sheet of paper with a large (relative to the size of handwritten numbers) predrawn circle on it. Indicate the top of the page. Step 2: Instruct patient to draw numbers in the circle to make the circle look like the face of a clock Step 3: Draw the hands of the clock to read "10 after 11."

4/8/10 Scoring Clock Drawing Test

Montreal Cognitive Assessment (MoCA)
Screening tool for mild cognitive dysfunction Cognitive Domains Attention and concentration Executive functioning Memory Language Visuoconstructional skills Conceptual thinking Calculations Orientation 10 Minutes to Administer Possible score of 30 26 or above is considered normal

Physical/ ADL Functioning
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Physical/ ADL Functioning Barthel Index Berg Balance Scale Katz Index of Independence in Activities of Daily Living Lawton Instrumental Activities of Daily Living Tinetti Mobility Scale Performance-Oriented Assessment of Balance Performance-Oriented Assessment of Gait Get-Up & Go Test

4/8/10 Barthel Index Self-report 2-3 minutes Trained observation 10-15 minutes 3 point scale for each item Assesses: Feeding Grooming Bowel & Bladder Continence Dressing Toileting Walking Stairs Bathing Originally designed for inpatient rehabilitation facilities; commonly used in community settings as well as institutional older adults. Lower scores associated with increased mortality. Not sensitive to changes in performance. Provides more comprehensive assessment of mobility.

Barthel Index

Katz Index of Independence in Activities of Daily Living
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Katz Index of Independence in Activities of Daily Living Performance measure Self-report Trained observer Scoring Letter score from A-G A= Most independent G= Most dependent Bathing Dressing Toilet use Transfer ability Feed self Maintenance of bowel & bladder continence This is the tool on which every other functional assessment tools have been built. Used with community dwelling, outpatient, nursing home or institutionalized, and hospitalized older adults. It is widely used to evaluate the outcomes of treatment. The responses are rated according to how much assistance an individual needs- from independent with no assistance needed, to needing some degree of assistance to being dependent on others to completing ADL’s. The scores from each of these areas is then evaluated to determine the score. A- independent in feeding, continence, transferring, toileting, dressing, and bathing B- Independent in all but one of these functional areas C- Independent in all but bathing and one other area D- Independent in all but bathing, dressing, and one other area E- Independent in all but bathing, dressing, toileting and one other area F- Independent in all but bathing, dressing, toileting, transferring, and one other area G- Dependent in all six areas A letter score is used from A (independent) to G (most dependent).

Lawton Instrumental Activities of Daily Living Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Lawton Instrumental Activities of Daily Living Scale Telephone usage Housekeeping* Food preparation* Laundry* Transportation Medications Money management Self-report of Performance Scoring O= Low functioning 8= High functioning Gender bias- transportation Intended for use with community dwelling, hospital based discharge planning. Because of the focus on the instrumental activities of daily living, it is not intended for older adults who are institutionalized. It could be performed as a self-report or information can be obtained from family. In this assessment, women complete all items. However, food preparation, laundry, housekeeping are eliminated for men. Eight is the maximum score earned on the Lawton which is indicative of high functioning levels in the IADLs. The lower the score, the greater the degree of impairment .

4/8/10 Get-Up & Go 5 point scale Higher score indicates more difficulty with gait and balance Scoring 1 = Normal 2 = Very slightly abnormal 3 = Mildly abnormal 4 = Moderately abnormal 5 = Severely abnormal Score of greater than 3 at risk for falling Can be performed as a timed assessment 1. Sit comfortably in a straight-backed chair. 2. Rise from the chair. 3. Stand still momentarily. 4. Walk a short distance (approximately 3 meters). 5. Turn around. 6. Walk back to the chair. 7. Turn around. 8. Sit down in the chair. You’re looking for undue slowness, hesitancy, abnormal movements of trunk or upper limbs, staggering, stumbling - a score greater than 3 indicates a greater risk for falls. This can also be used as a timed assessment.

4/8/10 Berg Balance Scale 14 item scale 5 point scale, ranging from 0-4 Completion time: minutes Equipment needed: Ruler Two standard chairs Footstool or step Stopwatch or wristwatch Scoring 41-56: Low fall risk 21-40: Medium fall risk 0-20: High fall risk

Tinnetti Mobility Scale Performance Oriented Assessment of Balance
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Tinnetti Mobility Scale Performance Oriented Assessment of Balance 3 point scale per item Used in conjunction with Gait Assessment Assessment Process: Sitting in chair Rising from chair Immediate standing balance Standing balance Balance with eyes closed Turning balance Nudge on sternum Neck turning One leg standing balance Back extension Reaching up Bending down Sitting down Only equipment needed is a straight back chair

Tinnetti Mobility Scale Performance-Oriented Assessment of Gait
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Tinnetti Mobility Scale Performance-Oriented Assessment of Gait 8 Items 2 point scale Assessment Process Initiation of gait Step height Step length Step symmetry Step continuity Path deviation Trunk stability Walk stance Turning while walking

Emotional/ Psychosocial
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Emotional/ Psychosocial PHQ-9 Geriatric Depression Scale Zung Self-Rating Depression Scale Cornell Scale for Depression in Dementia Zung Self-Rating Anxiety Scale WHOQOL-BREF

4/8/10 PHQ-9 Part of the Patient Health Questionnaire (PHQ) PHQ-9- Depression Module Self-report Multiple choice Measures severity of depression Implemented in the MDS3.0 Multiple choice, self report inventory developed by Pfizer Part of the Patient Health Questionnaire, PHQ-9 is the depression module of the PHQ Measures severity of depression

Geriatric Depression Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Geriatric Depression Scale 30 Questions Short version available- 15 questions Administration Self –administered Rater-administered Questionable with older adults with severe dementia Scoring >5 indicates potential depression- Should have a comprehensive assessment => 10 almost always indicative of depression Rater-administered versions produce lower scores than self-administered versions Questionable with older adults with dementia

Zung Self-Rating Depression Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Zung Self-Rating Depression Scale Screening tool Self-report 20 items 4 point scale Half of the items are positively worded; half negatively Respondents rate frequency of occurrence Older adults score higher than other age groups Older adults score higher than other age groups; possibly due to somatic complaints.

Cornell Scale for Depression in Dementia
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Cornell Scale for Depression in Dementia Assessment Areas Mood related signs Behavioral disturbances Physical signs Cyclic functions Ideational disturbance Administration Observation Interview Patient Caregiver 3 Point Scale 0- Absent 1- Mild or intermittent 2- Severe

Zung Self-Rating Anxiety Scale
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Zung Self-Rating Anxiety Scale Self-report 20 items 5 affective 15 somatic Score range: 20-80 Administration Time: minutes Used in psychiatric and medical patients and with normal older adults

World Health Organization Quality of Life (WHOQOL-BREF)
Measures the impact of disease Impact of disease and impairment of daily activities and behavior Perceived health measures Disability/ functional status measures 26 Questions Self-Administered Interviewer assisted or administered Manual is recommended to score the assessment

4/8/10 Pain Faces Pain Scale Numeric Scale Pain Thermometer Brief Pain Inventory Checklist of Nonverbal Pain Indicators Pain Assessment in Advanced Dementia Scale

4/8/10 Faces Pain Scale Originally developed for pediatrics No verbal component Language impairments Difficulty with expression 7 point scale

4/8/10 Numeric Scale Self-rating Scale of 0-20 O= No pain 20= Pain as bad as it could be Scores can be averaged over time May be presented horizontally or vertically, but the horizontal scale works well with individuals who have difficulty with abstract thought.

4/8/10 Pain Thermometer Verbal descriptor of pain Can be used with individuals with moderate to severe cognitive impairments as well as those with impaired verbal communication.

4/8/10 Brief Pain Inventory Widely used in clinical and research settings Originally developed for used with cancer patients Currently used with individuals experiencing chronic nonmalignant pain 16 items Measures pain and impact on daily function Completion time: 5 minutes (short form)

Checklist of Nonverbal Pain Indicators
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Checklist of Nonverbal Pain Indicators Measures pain in older adults with cognitive impairment Observation during movement and at rest Scoring: 0 or 1 6 items Nonverbal, vocal complaints Facial grimacing Bracing Restlessness Rubbing Verbal, vocal complaints

Pain Assessment in Advanced Dementia
Assessing the Geriatric Client: Tools for Recreational Therapy 4/8/10 Pain Assessment in Advanced Dementia Observation Score ranges from 0-10 points 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain 5 Areas Assessed Breathing Negative vocalization Facial expression Body language Consolabilty Observe for 5 minutes prior to scoring

Buettner Assessment of Needs, Diagnosis, and Interests for Recreational Therapy in LTC
BANDI-RT Utilizes information from MDS 3.0 Guides the therapist Identified problems Care plan Physician’s Orders RT treatment Flow sheet

Resources for Assessments
Iowa Geriatric Education Center Geriatric Assessment Tools Hartford Institue of Geriatric Nursing Try This Dementia Practice Guidelines for Recreational Therapy Buettner & Fitzsimmons (2003) Available through the ATRA Bookstore

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