Social and Psychologic Assessment of the Older Adult

A 78-year-old gentleman is brought to the emergency room with severe confusion. He has recently been discharged after treatment for congestive heart failure. The practitioner begins to perform a mental status exam, and the family questions why the practitioner is not looking at the condition of his heart. Which response would be the best response by the practitioner? "Currently, I am not concerned with the status of his cardiac system." "Well, as we all know, mental impairment is not a normal, age-related process. We need to determine which behaviors are impaired so we can provide proper interventions." "Since confusion is not a normal part of aging, we need to determine what issues are leading to his confusion. This mental health assessment will help us determine how we can best help." "Most older adults become confused at some point, should they live long enough. Before we begin to address his physical issues, we need him to calm down and cooperate with our examinations."

"Since confusion is not a normal part of aging, we need to determine what issues are leading to his confusion. This mental health assessment will help us determine how we can best help." This answer explains that this situation is not normal and further testing is needed to determine how to best plan appropriate interventions.

Match the questionnaire to the content it measures. 1. Patient's perception of family decision making 2. Satisfaction with the degree of social interaction 3. Number of friends you have contact with once a month 4. Presence of social support and areas in which it is lacking a. Family APGAR b. Norbeck Social Support Questionnaire c. Lubben Social Network Scale d. OARS Social Resource Scale

1. a 2. d 3. c 4. b

A 70-year-old female arrives at the clinic after falling and breaking her hip. Which information would be helpful to the nurse in determining the patient's ability to deal with her current physical limitations? Physical stamina Potential co-morbidities Availability of a strong social network Financial resources to provide for home health care

Availability of a strong social network A strong level of social support and well-being has been proven to positively affect the patient's ability to cope with physical impairments.

An 84-year-old homeless man is brought to the ED by local law enforcement. As the nurse performs the history, the man never looks up, provides appropriate answers, but with very few words, and tends to become teary. Which tools might be useful in further assessment of this individual? Select all that apply. MMSE SPMSQ Mini-Cog Beck Depression Inventory Short Form Geriatric Depression Scale

Beck Depression Inventory The Beck Depression Inventory is used to assess depression, but it is a lengthy assessment tool. Short Form Geriatric Depression Scale The Short Form Geriatric Depression Scale is a convenient instrument designed specifically for use with older people to screen for depression.

A nurse is preparing to perform a mental status assessment on an older adult woman with dementia. Which information might be gathered during such an assessment? Evidence of depression Evidence of physical abuse Cognitive functioning level Perception of satisfaction with family relationships

Cognitive functioning level Mental status assessments can help gauge the older adult's level of cognitive functioning.

An 88-year-old female is brought to her health care provider's office by her two children. The patient's husband has recently been moved to a nursing home. Her children are concerned about her withdrawal from the family and consistently staying in her room. In performing a social assessment, which questions would help the health care provider differentiate between an informal, a semiformal, and a formal support system? Select all that apply. Asking how often she visits with her family would relate to a semiformal support system. Determining which friends come to visit would be reflective of an informal support system. Asking about assistance from Health and Human Services would reflect a formal support system. Questions regarding participating in community activities would reflect a semiformal support system. Determining which sort of home health care the patient receives would reflect a semiformal support system.

Determining which friends come to visit would be reflective of an informal support system. Visitation with friends is an example of an informal support system. Family and friends are the primary participants in the informal support system. Asking about assistance from Health and Human Services would reflect a formal support system. Assistance from Health and Human Services would be reflective of a formal support system, which consists of public and private agencies. Questions regarding participating in community activities would reflect a semiformal support system. Community groups, faith-based groups, senior citizen centers, and clubs are all part of a semiformal support system.

An older male patient complains to his nurse that his immediate family doesn't take his health care issues seriously. Which tool might be most helpful in determining the functionality of this family? NSSQ SPMSQ Family APGAR OARS Social Resource Scale

Family APGAR The Family APGAR would be most helpful since it measures the patient's perception of family functioning.

When considering the older adult's family, which role could the nurse correctly expect the family members to assume? Family members can provide the best care for the older adult. Family plays a central role in the overall level of health and well-being. Family members make all the decisions regarding the care of the older adult. Family members provide the financial resources needed for the care of the older adult.

Family plays a central role in the overall level of health and well-being. Family provides the informal support system and plays a central role in the overall level of health and well-being for the older adult.

After speaking with an 80-year-old gentleman, the practitioner concludes that the patient is suffering from cognitive impairment. What might be the practitioner's next step? Nursing home placement Brain scan for potential tumor Formal testing of mental status Admission to an assistive living facility

Formal testing of mental status Formal, systematic testing of the patient's mental status will help the practitioner determine which behaviors are impaired and warrant intervention.

Observation of the older adult's living environment can shed light on that individual's social functioning. Why would it be important to perform a home visit as part of the objective social assessment? Older adults enjoy visitors in the home. Identification of necessary interventions can be made first hand. Visiting the home can provide insight into nursing home placement. Large numbers of individuals in the home can negatively impact social functioning.

Identification of necessary interventions can be made first hand. Looking at the living environment during a home visit can provide clues to interventions that may be needed.

A geriatric nurse is preparing to assess an 85-year-old female for cognitive functioning. Which tool might be appropriate to use? Select all that apply. NSSQ MMSE SPMSQ Mini-Cog Family APGAR

MMSE The Mini-Mental State Exam (MMSE) tests the cognitive aspects of mental function and would be useful. SPMSQ The Short Portable Mental Status Questionnaire (SPMSQ) is used to detect the presence and degree of intellectual impairment and would be useful. Mini-Cog The Mini-Cog is a shortened tool used to identify cognitive impairment and would be appropriate for use.

During a home visit with an 89-year-old recently widowed male, which observations would be valuable in determining if the patient is depressed? Select all that apply. Ability to recall events Awareness of environment Presence or absence of delusions Observations related to mood or affect General physical appearance, grooming, and hygiene

Observations related to mood or affect Observing the patient's mood or affect may be one of the first signs of depression. General physical appearance, grooming, and hygiene General physical appearance, good grooming, and personal hygiene can assist in the assessment of depression. Depressed individuals often forego their personal hygiene.

When assessing the social support of the older adult, which concept is most important to consider? Loss of job Financial resources Presence of a strong social network Information regarding activities of daily living

Presence of a strong social network It is important to assess for the presence of a strong social network that is providing support to the older adult. The mere presence of a social network does not necessarily mean that there is actual support.

While interviewing a 90-year-old gentleman, the geriatric nurse identifies cues that appear to signify depression. Which tool would be the best to further assess for depression in a 90-year-old individual? MMSE Mini-Cog Beck Depression Inventory Short Form Geriatric Depression Scale

Short Form Geriatric Depression Scale The Short Form Geriatric Depression Scale is a convenient instrument designed specifically for use with older people to screen for depression.

Which questions would be included in a social assessment of the older adult? Select all that apply. How often do you use tobacco products? How often do you drink alcoholic beverages? Tell me about your activities within your community. What sort of activities do you enjoy with your friends? Tell me about your family. How often do you see them?

Tell me about your activities within your community. Determining how active the patient is in the community is an important area in the social assessment. What sort of activities do you enjoy with your friends? Information relating to the patient's network of friends is a key component of a social assessment. Tell me about your family. How often do you see them? Identifying relationships with family members is a major component of the social assessment.

The MMSE is a validated tool used to assess cognitive aspects of mental functioning. Why do health care providers use it less frequently than other tools? The MMSE is too costly. The MMSE is now copyrighted. The MMSE is too long to use with older adults. The MMSE has been replaced by more sophisticated assessments.

The MMSE is now copyrighted. The authors of the MMSE have taken steps to enforce copyright protection, which is why it is disappearing from use.

The home health nurse has made multiple visits to the home of a 78-year-old female patient and her daughter. Previous visits have been unremarkable. During this visit, which situations might lead the nurse to question the family's economic stability? Select all that apply. The house is stifling, and the air conditioner is turned off. The daughter asks how many home visits will be paid for by Medicare. Although warm, the house is clean with clear pathways to the bathroom. When questioned about meals, the patient replies that she has been eating only cereal. When reviewing the patient's medications, she states that she no longer needs her blood pressure medicine and has opted not to refill it.

The house is stifling, and the air conditioner is turned off. Lack of air conditioning could stem from difficulty paying electric bills and could indicate financial instability. The daughter asks how many home visits will be paid for by Medicare. In a secure economic environment, this would not necessarily be a concern of the daughter. This could be indicative of economic distress. When questioned about meals, the patient replies that she has been eating only cereal. A response of eating cereal at all meals could reflect difficulty purchasing nutritious foods. When reviewing the patient's medications, she states that she no longer needs her blood pressure medicine and has opted not to refill it. Many patients will find reasons to stop taking medications if they create a financial hardship. This could be related to economic instability and should be further investigated.