Assessment of Health and Functioning in Older Adults Flashcards
Gerontology
Study of aging and older adults
- Focus: healthy and successful aging
- Address diversity among older adults
Geriatrics
Focuses on medical problems of older adults
- Shifted its focus from curing to caring
- Emphasis on quality of life
Positive Functional Consequences
Those that facilitate highest level of
functioning, least dependency and best
quality of life.
Functional Consequences
Observable effects of actions, risk factors
and age-related changes that influence
quality of life or day-to-day activities of
older adults.
Age-Related Changes
Inherent physiological processes that
increase vulnerability of older adults.
Negative Functional Consequences
Those that interfere with older adult’s
functioning or quality of life.
More about Age-related Changes
Inevitable, progressive and irreversible changes that happen to everyone.
- Physically degenerative
- Psychological and spiritual potential for growth
Risk Factors
Conditions that increase vulnerability
- Disease
- Environment
- Lifestyle
- Support systems
- Psychosocial circumstances
- adverse medication effects
- attitudes based on lack of knowledge
mnemonic: DELSPAA
Health
individual’s experience of sense of well-being, harmony and unity
Wellness
ability of older adult to function at highest capacity, despite the
presence of age-related changes and risk factors
Health Promotion:
programs or interventions that focus on behavior changes
in relation to environment
Environment
external conditions that impact health and wellbeing
How does an older adult stay well? Health promotion activities
- Prevention and screening
- Risk-reduction interventions
- Environmental modifications
- Health education
Continuum of care - Community
- Health promotion
- Respite services
- Adult day centers
Role of the nurse:
- Education
- Referrals
Continuum of care - Home Care
- Goal is rehabilitation
- Meal prep, personal care, errands, light housekeeping
Role of the nurse:
- Education
- Referrals
- Assessment
- Care planning
- Hands-on care
Continuum of care - Nursing Home
- Need 24 hr assistance with ADLs
Role of the nurse:
- Education
- Referrals
- Assessment
- Care planning
- Hands-on care
- Continuous on-site responsibility
- Coordinates with interprofessional
How does the nurse know which type of care an older adults needs?
Nursing assessments are done in any setting in which an older adult lives.
Types of Assessment
- Physical assessment
- Functional Assessment
- Mental Status assessment
- Comprehensive Geriatric assessment
- Environmental and safety Assessment
- Other assessment
Nursing Assessment Tool
To identify specific areas that need to be addressed in the Nursing care plan
Should be:
- Evidence based
- Easy to use
Interviewing Older adults
Preparing the physical setting
- Noise, lighting, comfortable furniture, privacy, bathroom
Establishing rapport
- Use formal names
- Explain the purpose
- Speak directly to the older person
- Maintain modesty standards set by each culture
Interviewing older adults: Structuring the Interview
- Brief interactions less than 30 minutes each
- Avoid Medical Jargon
- A summary of restatement
- Prepare the older person for the end of the interaction
Physical assessment
- Obtain the health history before starting physical assessment
- Head to toe (observational)
- Measuring vitals signs in older adults
- Temperature
- Pulse
- Respirations
- Blood pressure
- Orthostatic pressure
Functional Assessment
- Refers to measurement of person’s ability to fulfill responsibilities
and perform self-care task - It should measure primarily
- Activities of daily living (ADLS)
- Instrumental activities of daily living (IADLs)
- Level of assistance needing (ie. independent, semi-
independent, dependent) - Sensory function (ie. vision/hearing, etc.)
- Cognitive function (baseline mental status)
Common Functional Assessment tools
- The Katz Index of ADL’s
- 48/6
Mental Status Assessment
Assessment regarding cognitive ability and mood
- CAM
- Mini-mental state Examination (MMSE)
- Geriatric Depression Scale (GDS)
- Cornell scale for Depression in Dementia (CSDD)
Comprehensive Geriatric Assessment
-SPICES
S is for Sleep Disorders.
P is for Problems with Eating or Feeding.
I is for Incontinence.
C is for Confusion.
E is for Evidence of Falls.
S is for Skin Breakdown.
- Minimum DATA Set (MDS)
Environmental and Safety Assessment
- Fall Risk Assessment
- Braden scale
Health Assessments in Older Adults: Why are they so complicated
- It is common to have more than one chronic and acute issue
- Manifestation of illness or adverse medication effects tend to be
obscure, less predictable. - For every change, there may be multiple possible causes.
- Treatment often directed at symptoms not source of problem.
- Cognitive impairments affect accurate reporting.
- Myths may lead older adults or support people to falsely
attribute treatable conditions to “normal aging”
In what setting do Older Adults
experience the most functional decline?
Hospital
Home
Long term Care facilities
They experience functional decline equally in all settings
Hospitals
Functional decline occurs due to transitions in care
- Communication gaps
- Poor client education
- Unique patient characteristics (Language barrier, culture)
- Incomplete transfer of information
- poor med rec procedures
- low staffing
Which intervention most closely aligns with the practices of health promotion?
Question 1Select one:
a.
Providing presurgical teaching to an older adult prior to hip replacement
b.
Leading a flexibility and mobility class among older adults
c.
Administering medication to an older adult with osteoarthritis
d.
Teaching an older adult how to administer her inhaled medications independently
Leading a flexibility and mobility class among older adults
A hospital nurse is discussing with an older adult the possibility of transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer?
Question 2 Select one:
a.
Old people who go to the nursing home don’t get out.
b.
They will take my home if I go to the nursing home.
c.
My pneumonia enables me to qualify for skilled care in a nursing home.
d.
I don’t qualify for skilled care; I only had pneumonia.
My pneumonia enables me to qualify for skilled care in a nursing home
A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching?
Question 3Select one:
a.
“The day center can contribute to an actual improvement in dementia symptoms.”
b.
“The day center can give me respite.”
c.
“The day center can be a useful alternative to medical care.”
d.
“The day center can improve our quality of life.”
“The day center can be a useful alternative to medical care.”
An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client’s current situation is most likely to prompt this move?
Question 4 Select one:
a.
The development of a severe, acute health problem
b.
Exacerbation of a chronic health problem that may require medical treatment
c.
A change in the level of the client’s social support
d.
A decrease in the client’s level of function and activities of daily living (ADLs)
A decrease in the client’s level of function and activities of daily living (ADLs)
Active care management is often necessary in order to maintain wellness among older adults. Which older adult is most likely to require care management?
Question 5Select one:
a.
77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier
b.
90-year-old man who lives alone and has no living family members
c.
81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly
d.
90-year-old man who has recently been transferred from an assisted living facility to an acute care setting
90-year-old man who lives alone and has no living family members
A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients?
Question 6Select one:
a.
Provide care that is primarily focused on acute, rather than chronic, health problems.
b.
Encourage older adults to make care providers aware of each chronic condition they live with.
c.
Teach older adults to be astute with their spending and saving patterns.
d.
Become familiar with the various funding sources and their eligibility requirements.
Become familiar with the various funding sources and their eligibility requirements.
Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which problem is most likely to precipitate admission to long-term care?
Question 7Select one:
a.
Chronic kidney disease
b.
Traumatic Injury
c.
Terminal cancer diagnosis
d.
Dementia
Dementia
A nursing administrator of the long-term care facility starts a quality of life improvement program for older adults. Which activity should be included in the program?
Question 8Select one:
a.
Divide the residents according cognitive ability.
b.
Assess personal choices.
c.
Emphasize safety and medical care.
d.
Decrease the use of pain medications.
Assess personal choices.
Older adults with complex medical problems are vulnerable to experiencing problems as they transition between care settings. All of these factors compromise client safety except one.
Question 9Select one:
a.
Ineffective medication reconciliation procedures
b.
Client age
c.
Communication gaps
d.
Client characteristics
e.
Poor coordination of services
Client age
A nurse is responsible for assessing an older adult in an acute care setting. Which statement most accurately captures the complexity involved in assessing the older adult?
Question 10Select one:
a.
Older adults experience fewer acute health problems but more chronic illnesses than do younger clients.
b.
Signs and symptoms of illness are often obscure and less predictable among older adults.
c.
Care must be taken to avoid assessing normal, age-related changes.
d.
Older adults manifest fewer symptoms of illness than do younger clients.
Signs and symptoms of illness are often obscure and less predictable among older adults.
