NURS 445 Exam 2: Assessment of Older Adult

Functional Assessment

- Assessment used to identify an older adult's ability to perform self-care, self-maintenance, and physical activities, then plan appropriate nursing interventions based on the results. - There are two approaches: One approach is to ask questions about ability, and the other approach is to observe ability through evaluating task completion. Our verbal and observational tools tend to screen for "disability." Disability refers to the impact that health problems have on an individual's ability to perform tasks, roles, and activities, and it is often measured by asking questions about the performance of activities of daily living (such as eating and dressing) and instrumental activities of daily living (such as meal preparation and hobbies).

Obesity

A major health problem among Americans, including older American, and it is associated with chronic disease and disability. It is a major risk factor for decline in function ability (as assessed by needing assistance with ADLs and IADLs). Providing care to obese persons places caregivers, both family and staff members, at risk for injury.

Dementia

A permanent progressive decline in cognitive function. Alzheimer's disease is the most common form of dementia. Typically, it is manifested by both impaired memory (long- or short-term) and inability to learn or recall new information, and is distinguished by one (or more) of the following cognitive disturbances: aphasia (impaired ability to communicate), apraxia (Inability to perform purposeful movements), agnosia (Loss of ability to understand auditory, visual, or other sensations), or disturbance in executive functioning.

Body Mass Index (BMI)

A ratio of weight in pounds to height in inches squared, as an assessment tool. The BMI is a number usually between 16 and 4; a BMI between 25 and 29 is considered "overweight" and more than 30 is considered "obese."

Geriatric Depression Scale (GDS)

A tool widely used by nurses to assess symptoms of depression. The interviewer asks the older person a set of 30 questions with possible answers of yes or no. A "negative" response, which depending on the question may be a yes or no answer, is cored as one point; a higher score indicates more symptoms of depression. A score of 0-30 is possible, with 0-9 being normal, 10-19 indicating mild depression, and 20-30 indicating severe depressive symptoms.

Cognitive Assessment

Changes in cognitive function with age vary among older adults and are difficult to separate from other comorbidities (physical and psychological conditions), other age-related changes (for example, hearing), the side effects of medications, and changes in intellectual activity. -- Generally speaking, older adults manifest a gradual and modest decline in short-term memory and experience a reduction in the speed with which new information is processed. -- Tool: 1. Mini Mental State Examination (MMSE)

Quality of Life

Encompasses all areas of everyday life: environmental and material components as well as physical, mental, and social well-being. It is highly individualistic among older adults; it is also subjective and multidimensional in scope.

Social Assessment

Individuals with low quantity and quality of social relationships have a higher morbidity and mortality risk compared with those who have good quantity and quality of social contacts. This assessment includes collecting information on the presence of a social network and on the interaction between the older adult and family, friends, neighbors, and community. Asking question from Lubben Social Network Scale and Seeman and Berk will help assess the adequacy and range of support available to an older adult. Nurses should be asking questions about social support and social function as part of the comprehensive assessment.

Interpretation of the Lubben Social Network Scale:

Interpretation: • minimum score: 0 • maximum score: 50 • The higher the score the greater the level of social support. • A score < 20 indicates a person who may have an extremely limited social network. Score Interpretation < 20 isolated 21 - 25 high risk for isolation 26 - 30 moderate risk for isolation >= 31 low risk for isolation

Successful Aging

It is related to quality of life and is associated with community living, successful aging. Elements of this type of aging can include self-acceptance, positive relationships with others, and personal growth. Also associated with longevity.

Nurse assessment in obesity:

Nurses can assess for overweight and obesity using the BMI and by asking about a history of weight change. If food intake is a concern, a common approach is to begin with a 3- to 7-day meal diary. This information can assist in determining a person's food habits. This is an area of assessment where nurses could benefit from working with the nutritionist and the dietitian, who have a specialized knowledge base.

Depression Diagnosis

Older American may experience minor depression on a chronic basis but not meet the established criteria for clinical or major depression. To meet the DSM-4 criteria, an older adult must experience five or more of the following symptoms during a 2-week period: 1. Sadness 2. Lack of enjoyment of previously enjoyed activities 3. Significant weight loss 4. Sleep disturbance 5. Restlessness 6. Fatigue 7. Feelings of worthlessness 8. Impaired ability to think clearly or concentrate 9. Suicide ideation or attempt

Religiosity

Refers to believing in God, organized rituals, and specific dogma; spirituality refers more broadly to ideas of belief that encompass personal philosophy and an understanding of meaning and purpose in life.

Psychological Assessment

The assessment presents a wide continuum from positive mental health to mental health problems, and the tendency seems to be weighted toward assessment of mental health disorders. Two areas of psychological assessment include quality of life and depression.

Comprehensive Assessment

The basis of an individualized plan of care for an older adult. It is the corner stone of gerontological nursing, and the goal is to conduct a systematic and integrated assessment. - The health and healthcare needs of older adults are complex, deriving from a combination of age-related changes, age-associated and other diseases, heredity, and lifestyle. Assessment requires knowledge and an understanding of these complex factors, and a comprehensive baseline assessment is necessary in order to recognize changes that occur in relation to these complex factors.

Seeman and Berkman (1988)

The more important aspects of social support may be the number of supportive persons and the various types of support (emotional, instrumental, and informational) that are available. This social assessment tool relates to older adults living in the community and has identified four questions that assess the adequacy of social support. These questions are: 1. When you need help, can you count on anyone for house cleaning, groceries, or a ride? 2. Could you use more help with daily tasks? 3. Can you count on anyone for emotional support (talking over problems or helping you make a decision)? 4. Could you use more emotional help (receiving sufficient support)?

Clinical depression

The most common mental health problem among older adults, and it often goes undetected because clinicians attribute depressive symptoms to age-associated changes, chronic physical illness, medication side effects, or pain. The consequences of this mental illness can be serious and include suicidal ideation and suicide attempts.

Mini Mental State Examination (MMSE)

The most extensively used cognitive assessment tool. It measures orientation, registration, attention and calculation, short-term recall, language, and visuospatial function.

Quality of Life and Successful Aging

The two central concepts in assessment and care of older adults. Assessment of these two concepts can assist in better understanding the psychological health of older adults.

Spiritual Assessment

This assessment is an integral part of comprehensive assessment and provides a basis for an individualized plan of care. Although there is a link between religiosity and spirituality, the two concepts are not synonymous.

Lubben Social Network Scale

This assessment tool can be used to assess the level of social support available to an elderly patient. This can help identify a person who may need assistance or help and when. It is a social assessment tool that contains 10 items, 3 of which have been found to differentiate those who are isolated from those who are not. These questions are: 1. Is there any one special person you could call or contact if you needed help? 2. In general, other than your children, how many relatives do you feel close to and have contact with at least once a month? 3. In general, how many friends do you feel close to and have contact with at least once a month?

Advanced Activities of Daily Living

Tools that measure societal, family, and community roles, as well as participation in occupational and recreational activities. These tools tend to be used less oftenby nurses and more often by OTs and recreation workers to address specific areas of social tasks. The strength about COPM is that is focuses on the older adult's functional priorities by asking about importance so that interventions can be tailored to enhance those priority activities and increase satisfaction. Tasks Typically Assessed with COMP AADL Assessment Tool: 1. Self-care activities (personal care, functional mobility, and community management) 2. Productivity (paid/unpaid work, household management, and play/school) 3. Leisure (quiet recreation, active recreation, and socialization).

Activities of Daily Living

Used to assess measurements associated with self-care, bowel and bladder, transfer, locomotion, communication, and social cognition. This measure is done at admission, discharge, and several times in between to assess progress in rehabilitation. Tasks Typically Assessed with ADL Assessment Tools: 1. Eating 2. Dressing 3. Bathing/washing 4. Grooming 5. Walking/ambulation 6. Ascending/descending stairs 7. Communication 8. Transferring (e.g., from bed to chair) 9. Toileting (bowel and bladder)

Instrumental Activities of Daily Living

include a range of activities that are considered to be more complex compared with ADLs and address the older adult's ability to interact with his or her environment and community. Items in these assessment tools are geared more for older adults living in the community; for example, items often ask about doing the laundry or shopping for groceries. They emphasize tasks traditionally associated with women's work in the home. Tasks Typically Assessed with IADL Assessment Tools: 1. Using the telephone 2. Taking medications 3. Shopping 4. Handling finances 5. Preparing meals 6. Laundry 7. Light or heavy housekeeping 8. Light or heavy yard work 9. Home maintenance 10. Using transportation 11. Leisure/recreation