Chapter 6: Comprehensive Assessment of the Older Adult

1. Chapter 6: Comprehensive Assessment of the Older Adult

2. Learning Objectives • Identify the major components of comprehensive assessment of older adults, including functional, physical, cognitive, psychological, social, and spiritual assessments. • Name tools that are frequently used in the assessment of older adults. • Recognize the challenges of conducting comprehensive assessments of older adults. • Value the role of other health professionals in the assessment of older adults. • Describe some of the issues in relation to comprehensive assessment of older adults.

3. Comprehensive Assessment • Basis of an individualized plan of care for an older adult is a comprehensive assessment • A comprehensive baseline assessment is necessary to recognize changes that occur in relation to these complex factors.

4. Functional Assessment • Identify an older adult’s ability to perform • Self-care • Self-maintenance • Physical activities • Minimum Data Set (MDS): OBRA mandated the use of the MDS in 1987 • Activities of Daily Living (ADL) • Instrumental Activities of Daily Living (IADL) • Advanced Activities of Daily Living (AADL)

5. Question When a nursing home uses the Minimum Data Set (MDS), the nurse is assured that: • A clinical nurse specialist is available at regularly scheduled intervals • The nursing home is meeting federal regulations • Regular dental care is being provided • Residents receive high-quality care

6. Physical Assessment • Conducting Physical assessment is based on technical competence in physical assessment, knowledge of the normal changes and diseases associated with aging, and good communication skills • Systems approach • Circulatory Function - Respiratory Function • Gastrointestinal Function - Genitourinary Function • Sexual Function - Neurological Function • Musculoskeletal Function - Sensory Function • Endocrine and Metabolic Function - Integumentary Function • Hematologic and Immune Function

7. Cognitive Assessment • Age-related changes vary among older adults; are difficult to separate from other physical and psychological conditions, or other age-related changes • Mini Mental State Examination (MMSE)- Box 6-5 • Dementia • Alzheimer’s is most common form of dementia

8. Psychological Assessment • Quality of life • Successful aging • Clinical Depression • Geriatric Depression Scale (GDS): Box 6-7, p. 173

9. Geriatric Depression Scale (GDS) – short form Choose the best answer for how you have felt over the past week: 1. Are you basically satisfied with your life? YES / NO 2. Have you dropped many of your activities and interests? YES / NO 3. Do you feel that your life is empty? YES / NO 4. Do you often get bored? YES / NO 5. Are you in good spirits most of the time? YES / NO 6. Are you afraid that something bad is going to happen to you? YES / NO 7. Do you feel happy most of the time? YES / NO 8. Do you often feel helpless? YES / NO 9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO 10. Do you feel you have more problems with memory than most? YES / NO 11. Do you think it is wonderful to be alive now? YES / NO 12. Do you feel pretty worthless the way you are now? YES / NO 13. Do you feel full of energy? YES / NO 14. Do you feel that your situation is hopeless? YES / NO 15. Do you think that most people are better off than you are? YES / NO • Answers in bold indicate depression. Score 1 point for each bolded answer. • A score > 5 points is suggestive of depression. • A score ≥ 10 points is almost always indicative of depression. • A score > 5 points should warrant a follow-up comprehensive assessment.

10. Social Assessment • Those with low quantity and quality of social relationships have a higher morbidity and mortality risk (p. 174) • Lubben Social Network Scale Ex) “ Is there anyone special person you could call or contact if you need help?” • Seeman and Berkman Ex) “Can you count on anyone for emotional support?”

11. Other Assessment • Spiritual assessment helps provides a basis for an individualized plan of care • Obesity • Body Mass Index (BMI): ratio of wt. to ht. • History of weight change • 3-to-7 day meal diary • Consultation with nutritionist or dietician *To calculate your BMI, go to website: www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi

12. Individualized Plan of Care • 10 Principles of Comprehensive Assessment (Box 6-9, P. 177) • The cornerstone of an individualized plan of care for an older adult is a comprehensive assessment. • Comprehensive assessment takes into account age-related changes, age-associated and other diseases, heredity, and lifestyle. • Nurses are members of the healthcare team, contributing to and drawing from the team to enhance the assessment process. • Comprehensive assessment is not a neutral process.

13. Individualized Plan of Care • Ideally, the older adult is the best source of information to assess his or her health. When this is not possible, family members or caregivers are acceptable as secondary sources of information. When the older adult cannot self-report, physical performance measures may provide additional information. • Comprehensive assessment should first emphasize ability and then address disability. Appropriate interventions to maintain and enhance ability and to improve or compensate for disability should follow from a comprehensive assessment.

14. Individualized Plan of Care • Task performance and task capacity are two difference perspectives. Some assessment tools ask, “Do you dress without help?’ (performance) whereas others ask, “Can you dress without help?” (capacity). Asking about capacity will result in answers that emphasize ability. • Assessment of older adults who have cognitive limitations may require task segmentation, or the breaking down of tasks into smaller steps.

15. Individualized Plan of Care • Some assessment tools or parts of assessment tools may be more or less applicable depending on the setting, that is, community, acute care, or long-term care settings. • In comprehensive assessment, it is important to explore the meaning and implications of health status from the older adult’s perspective. For example, the same changes in visual acuity for two older adults may have quite different meanings and implications for everyday life.

16. Summary • Comprehensive assessment is essential component of geriatric nursing care • Both objective and subjective data is needed • All aspects of the older adult should be considered: physical, psychological, socioeconomic, and spiritual.

17. Question Which of the following reflects aging changes in the GI system? a. Increased peristaltic action b. Increased gastric acid secretion c. Urinary incontinence d. Constipation