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Chapter 6: Comprehensive Assessment of the Older Adult

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Chapter 6: Comprehensive Assessment of the Older Adult – PowerPoint PPT presentation

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Title: 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 adults 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
  • Alzheimers 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.

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/b
    mi

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
  1. 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.
  2. 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
  1. 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.
  2. 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
  1. 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.
  2. In comprehensive assessment, it is important to
    explore the meaning and implications of health
    status from the older adults 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
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