Gerontology Assessment

Question 1

communication and patient education with the older adult

Answer 1

-create environment that is conducive to exchange of information
-establish trust, caring, confidentiality
-consider sensory and MSK changes
-assess learning needs first
-consider health literacy level

Question 2

strategies for communication with geriatrics

Answer 2

space, positioning, adaptive equipment, noise, distractions, room temperature, lighting, patience, unhurried pace, lower tone of voice, slow rate of speech, articulate, one question at a time,
-teach when alert, rested; in small increments; involve the individual in the teaching; focus on individual’s strengths; changes are not made easily; evaluate the teaching

Question 3

Tailoring the Assessment to the Individual

Answer 3

Environmental modifications; look for natural opportunities for assessment (meals, social activities)

Question 4

components of the assessment

Answer 4

interview and health history , physical assessment , specific assessment

Question 5

spices

Answer 5

sleep disorder, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown

Question 6

factors that affect the norm

Answer 6

lab values- medications, co-morbidities
atypical presentation of illness- compare to individuals base line
loss or decrease in compensatory reserve
progressive loss in ability to repair damaged tissue
decreased immune response

Question 7

challenges with assessment

Answer 7

nonspecific signs and symptoms, atypical presentation of illness, differentiation of normal aging vs. disease, sensory deficits, anxiety, reduced energy level, pain, multiple health issues, tendency to reminisce

Question 8

sensory changes

Answer 8

can lead to anxiety
-causes of deprivation - reduced sensory capacities, restrictive, monotonous environments
-sensory overload- related to abrupt change, major fact for development of delirium in the hospital

Question 9

types of sensory changes

Answer 9

smell- decreased
taste-modest decrease
tactile- decreases due to skin changes
eye and vision- astigmatism, cataracts, glaucoma, need for more light
auditory- presbycusis

Question 10

integumentary

Answer 10

skin assessment- determine hydration status, potential for infection
changes in older adult- decreased thickness, elasticity
-dry skin (xerosis)- causes pruritus (itching)
-decreased vascular supply to skin and glands- decreased sweating
-decreased sensation
-decreased subcutaneous fat- affect body’s cooling system
(more water in muscle)
hair- melanin decreases
men- increased hair in ears, nose, and eyebrows
women- hair on face and chin due to hormonal influences
nails- brittle, flat, pigment changes

Question 11

uneven pigmentation

Answer 11

age spots

Question 12

seborrheic keratoses

Answer 12

thick, brown raised lesions

Question 13

cherry angiomas

Answer 13

increased vascularity in dermis

Question 14

skin tags

Answer 14

small flesh-colored tumors

Question 15

dermatoporosis

Answer 15

chronic skin fragility
skin changes- actinic purpura, white pseudoscars

Question 16

arterial ulcers

Answer 16

pain with exercise or at rest
-cramping, burning, aching
-cool, thin, shiny, dry
-loss of hair
-thick toe nails
-ulcers- outer angle, feet, toes
-treatment- revascularization

Question 17

venous ulcers

Answer 17

-stasis ulcers
-brownish skin discoloration (accumulation of erythrocytes)
-medial aspect of lower leg
-flat, shallow, exudate
-treatment: prolonged elevation and compression therapy

Question 18

diabetic lesions

Answer 18

neuropathy- risk factor
-foot inspection and care
-risk of amputation

Question 19

pressure injury assessment

Answer 19

major risk factors: shearing, friction, moisture, nutritional status (protein deficiency)
assessment tools- norton risk assessment scale, braden scale

Question 20

musculoskeletal

Answer 20

-changes in stature and posture
-decreased bone density
-decreased joint movement
-vertebral disc height thins
-less flexibility
-sarcopenia- age related changes to muscles - tissue mass decreases and decreased strength and stamina

Question 21

cardiovascular

Answer 21

-arterial wall thickening and stiffening
-left ventricular and atrial hypertrophy
-sclerosis of atrial and mitral valves
-strong arterial pulses, diminished peripheral pulses, cool extremities
-decreased cardiac reserve and efficiency

Question 22

arteriosclerosis

Answer 22

narrowing of blood vessels

Question 23

atherosclerosis

Answer 23

plaque on vessel

Question 24

respiratory

Answer 24

-decreased respiratory muscle strength; stiffer chest wall
-diminished ciliary and macrophage activity, drier mucus membranes
-decreased cough reflex
-increased risk of aspiration
-decreased lung capacity

Question 25

renal and urological

Answer 25

-loss of nephrons (filtration unit) , kidney mass, ability to concentrate urine
-decreased kidney size and decreased blood flow to kidneys
- decreased glomerular filtration rate (GFR)
-unable to tolerate dehydration or fluid overload as well as younger adult
kidney failure- fluid retention, edema , high bp, itching, confusion, anemia
-dialysis- kidneys lose all function, run blood through device to filter

Question 26

digestion and nutriton

Answer 26

• decreased sensitivity to insulin
  -changes in dental health
  -decreased taste buds and salivary secretions
  -decreased digestive juices
  -slower peristalsis- GERD
  -decreased absorption of nutrients
  -constipation is not a normal part of aging
  -incidence of gallstones increases- decrease bile of salt synthesis
  -increased potential for malnutrition

Question 27

nervous system

Answer 27

-most changes in aging are seen in CNS- decrease in brain weight and size
-loss of deep sleep
-subtle changes in cognitive and motor functioning and balance
-slower PNS functioning, prolonged recovery
-Kinesthetic perception is not as reliable - increased risk of falls

Question 28

reproductive system

Answer 28

women- menopause (osteoperosis), structural changes typical of aging muscle and skin, vaginal dryness
men- able to procreate entire lives following puberty, but structure changes may interfere with sperm motility. Benign prostatic hypertrophy is another common issue

Question 29

other changes include

Answer 29

decreased antibodies, slower healing, reduced cellular immunity, lean body mass declines and body water is lost, temperature regulation issues, risk of hypo/hyperthermia due to decreased shivering, slow metabolism. decreased sweating, decreased perception of hot and cold

Question 30

SPICES

Answer 30

sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown

Question 31

functional assessment

Answer 31

-important because actual age does not reveal individual ability
-hospitalized older adults are at risk for loss of function skills
-loss of function is the major cause of institutionalization

Question 32

goals of functional assessment

Answer 32

-restore/ improve health
-monitor changes in health
-enhance independence
-idenitfy disabilities
-screen for issues needing further assessment and referral
-evaluate need for community resources, equipment

Question 33

components of functional assesment

Answer 33

environmental, physical, psychological, socio-economical

Question 34

activities of daily living

Answer 34

tasks needed for self care (Katz)
instrumental activities of daily living

Question 35

mobility

Answer 35

upper extremity- touch palms to back of head, reach up over head, touch hands together behind waist
lower extremity- get up and go test
-indicators for therapy- gait and balance