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