Week 14: Functional Assessment of the Older Adult
Barthel index
ADL index often used to follow progress in rehabilitation settings
formal supports
Include programs such as social welfare and other social service and health care delivery agencies such as home health care
functional ability
One's ability to perform activities necessary to live in modern society
Continuing-care retirement communities
Unique feature is that all care needs for the older adult can be met in one community
high-frequency range
is hearing loss usually high or low frequency range that is lost?
85 and older
old-old age range
65-74
young-old age range
DAFA
10-item observational instrument for use with adults with dementia; requires the person to demonstrate tasks of money management, shopping, hobbies, meal preparation, awareness, reading, and transportation
C
10. During a morning assessment, the nurse notices that an older patient is less attentive and is unable to recall yesterdays events. Which test is appropriate for assessing the patients mental status? a. Geriatric Depression Scale, short form b. Rapid Disability Rating Scale-2 c. Mini-Cog d. Get Up and Go Test
Tinetti gait and balance evaluation
28 point tool that is performed by trained observers
A
A patient will be ready to be discharged from the hospital soon, and the patients family members are concerned about whether the patient is able to walk safely outside alone. The nurse will perform which test to assess this? a. Get Up and Go Test b. Performance ADLs c. Physical Performance Test d. Tinetti Gait and Balance Evaluation
rapid disability rating scale
ADL index completed by a family member or professional care-giver familiar with the abilities of the older adult that is designed to measure what the person can actually do versus what he or she could possibly do
Functional independence measure
ADL index that has been widely tested on older adults and has a telephone, in-person, and proxy version
FIM
ADL index that is more sensitive to change than the other ADL instruments and takes formal training and more time consuming
Barthel index
ADL instrument that includes definitions of each task to facilitate ease of scoring, and has a comprehensive assessment of mobility
AADL
Activities older adults perform as family member, member of society and community, including occupational and recreational activities
A
An 85-year-old man has been hospitalized after a fall at home, and his 86-year-old wife is at his bedside. She tells the nurse that she is his primary caregiver. The nurse should assess the caregiver for signs of possible caregiver burnout, such as: a. Depression. b. Weight gain. c. Hypertension. d. Social phobias.
B
An appropriate tool to assess an individual's instrumental activities of daily living would be a tool by: A. Katz B. Lawton C. Tinetti D. Norbeck
B
An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8 hours, his condition has stabilized and he is transferred to a medical unit. The family is wondering whether he will be able to go back home. Which assessment instrument is most appropriate for the nurse to choose at this time? a. Lawton IADL instrument b. Hospital Admission Risk Profile (HARP) c. Mini-Cog d. NEECHAM Confusion Scale
D
An older person is experiencing an acute change in cognition. The nurse recognizes that this disorder is: A. Alzheimer's dementia B. ADHD C. Depression D. Delirium
A
Assessment of the "social" domain, includes: A. Family relationships B. The ability to cook meals C. The ability to balance the checkbook and pay bills D. Hazards found in the home
semiformal support
Church society, neighborhood group, senior centers
Lawton Instrumental Activities of Daily Living
Designed as a self-report measure of performance rather than ability; direct testing is often not feasible
B
During a functional assessment of an older persons home environment, which statement or question by the nurse is most appropriate regarding common environmental hazards? a. These low toilet seats are safe because they are nearer to the ground in case of falls. b. Do you have a relative or friend who can help to install grab bars in your shower? c. These small rugs are ideal for preventing you from slipping on the hard floor. d. It would be safer to keep the lighting low in this room to avoid glare in your eyes.
social assessment
Focuses on relationships within family, social groups, and community; comprises multiple dimensions, including the sources of formal and informal assistance available from those relationships
Katz index
Foundation for most of the newer functional assessment instruments based on concept of physical disability and is intended to measure physical function in older adults and the chronically ill
Medical status, Functional capabilities, Psychosocial status
Goal of Geriatric Assessment is to determine a patient's:
functional status
Individual's actual performance of activities and tasks associated with his or her current life roles
bilateral
Is hearing loss usually unilateral or bilateral?
katz index
Measures function at the current point in time and is valuable for planning specific types of assistance that the older person may need
IADLs
Measuring functional abilities necessary for independent community living
informal support
Partly based on cultural beliefs regarding who should be providing care, prior relationships, and location and availability of the caregiver; includes family and close long-time friends, and is usually provided free of charge
delirium
Presents as an acute change in cognition, affecting the domain of attention; usually attributable to an acute illness such as an infection or a medication side effect
modified caregiver strain index
Screening tool that identifies caregivers needs; Brief tool with 13 questions addressing potential strain in employment, financial, physical, social, and time domains
true
T or F: Depression can be associated with a change in physical ability or loss of fxn.
true
T or F: Depression is a common, reversible psychiatric condition.
false
T or F: Depression is a natural part of aging.
true
T or F: In general, a gradual and mild-to-moderate decline in short-term memory may be attributable to aging
B
The nurse is assessing an older adult who has had surgery for a fractured hip and a history of dementia. The nurse should keep in mind that older adults with cognitive impairment: A. Experience less pain B. Can provide a self-report of pain C. Cannot be relied on to self-report pain D. Will not express pain sensations
A
The nurse is assessing an older adults advanced activities of daily living (AADLs), which would include: a. Recreational activities. b. Meal preparation. c. Balancing the checkbook. d. Self-grooming activities.
D
The nurse is assessing an older adults functional ability. Which definition correctly describes ones functional ability? Functional ability: a. Is the measure of the expected changes of aging that one is experiencing. b. Refers to the individuals motivation to live independently. c. Refers to the level of cognition present in an older person. d. Refers to ones ability to perform activities necessary to live in modern society.
D
The nurse is assessing the forms of support an older patient has before she is discharged. Which of these examples is an informal source of support? a. Local senior center b. Patients Medicare check c. Meals on Wheels meal delivery service d. Patients neighbor, who visits with her daily
D
The nurse is assessing the patient's ability to bathe and dress herself. The nurse knows this type of assessment is considered: A. The Mini-Cog B. Independent activities of daily living. C. Dependent activities of daily living. D. Activities of daily living.
C
The nurse is preparing to assess an older adult and discovers that the older adult is in severe pain. Which statement about pain and the older adult is true? a. Pain is inevitable with aging. b. Older adults with cognitive impairments feel less pain. c. Alleviating pain should be a priority over other aspects of the assessment. d. The assessment should take priority so that care decisions can be made.
A
The nurse is preparing to perform a functional assessment of an older patient and knows that a good approach would be to: a. Observe the patients ability to perform the tasks. b. Ask the patients wife how he does when performing tasks. c. Review the medical record for information on the patients abilities. d. Ask the patients physician for information on the patients abilities.
B
The nurse is preparing to use the Lawton IADL instrument as part of an assessment. Which statement about the Lawton IADL instrument is true? a. The nurse uses direct observation to implement this tool. b. The Lawton IADL instrument is designed as a self-report measure of performance rather than ability. c. This instrument is not useful in the acute hospital setting. d. This tool is best used for those residing in an institutional setting.
C
The nurse needs to assess a patients ability to perform activities of daily living (ADLs) and should choose which tool for this assessment? a. Direct Assessment of Functional Abilities (DAFA) b. Lawton Instrumental Activities of Daily Living (IADL) scale c. Barthel Index d. Older Americans Resources and Services Multidimensional Functional Assessment QuestionnaireIADL (OMFAQ-IADL)
B
When beginning to assess a persons spirituality, which question by the nurse would be most appropriate? a. Do you believe in God? b. How does your spirituality relate to your health care decisions? c. What religious faith do you follow? d. Do you believe in the power of prayer?
B
When using the various instruments to assess an older persons ADLs, the nurse needs to remember that a disadvantage of these instruments includes: a. Reliability of the tools. b. Self or proxy reporting of functional activities. c. Lack of confidentiality during the assessment. d. Insufficient details concerning the deficiencies identified.
C
Which of the following statements is true regarding an individual's functional status? A. Functional status refers to one's ability to care for another person B. An older adult's functional status is usually static over time C. An older adult's functional status my vary from independence to disability
IADL instruments
address higher-order components of the Katz ADL scale and measure more complex ADL's required for a person to adapt to the environment
HARP
assesses patients using age, an abbreviated 21-point Folstein Mini-Mental State Exam (MMSE), and IADL preadmission status
social network
consist of informal supports that are accessed by the older adults
norbeck social support questionnaire
developed to measure the multiple components of social support; allows the individual to rate his or her own social network and perceived social support from the network and can also be used to measure social support with caregivers
5
katz index takes approximately _____ minutes to administer
75-84
middle-old age range
cognitive assessment
provides continuing comparisons with the individual's baseline to detect any acute changes such as with delirium
home care
refers to a range of supportive social and health services provided in the home environment
get up and go test
reliable and valid test to quantify functional mobility; can predict a person's ability to go outside alone safely
ADLs, IADLs, and mobility
three overarching domains of the functional assessment
older age, impaired cognitive functioning (MMSE), reduced IADL ability within 2 weeks before admission
three predictive values for ADL loss during and after hospitalization for an acute medical illness