Chapter%206:%20Comprehensive%20Assessment%20of%20the%20Older%20Adult

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Chapter 6 Comprehensive Assessment of the Older
Adult
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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.

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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.

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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), p. 153
• Instrumental Activities of Daily Living (IADL) p.
  154
• Advanced Activities of Daily Living (AADL)

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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

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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
• Mini-Cog
• Dementia
• Alzheimers D. is most common form of dementia

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Psychological Assessment

• Quality of life
• How would you describe your quality of life?
• Successful aging
• Would you describe yourself as someone who is
  aging successfully?
• Clinical Depression
• Geriatric Depression Scale (GDS) Box 6-7, p. 173

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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.

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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?

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Other Assessment

• Spiritual assessment helps provides a basis for
  an individualized plan of care
• Is religion or God significant to you?,
• What is your source of strength and hope?
• Obesity
• Body Mass Index (BMI) ratio of wt. to ht.
• History of weight change
• 3-to-7 day meal diary to determine food habits.
• Consultation with nutritionist or dietician
• To calculate your BMI, go to website
  www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/b
  mi

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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.

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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.

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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.

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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.