Gerontology Assessment Flashcards
communication and patient education with the older adult
-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
strategies for communication with geriatrics
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
Tailoring the Assessment to the Individual
Environmental modifications; look for natural opportunities for assessment (meals, social activities)
components of the assessment
interview and health history , physical assessment , specific assessment
spices
sleep disorder, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown
factors that affect the norm
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
challenges with assessment
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
sensory changes
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
types of sensory changes
smell- decreased
taste-modest decrease
tactile- decreases due to skin changes
eye and vision- astigmatism, cataracts, glaucoma, need for more light
auditory- presbycusis
integumentary
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
uneven pigmentation
age spots
seborrheic keratoses
thick, brown raised lesions
cherry angiomas
increased vascularity in dermis
skin tags
small flesh-colored tumors
dermatoporosis
chronic skin fragility
skin changes- actinic purpura, white pseudoscars
arterial ulcers
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
venous ulcers
-stasis ulcers
-brownish skin discoloration (accumulation of erythrocytes)
-medial aspect of lower leg
-flat, shallow, exudate
-treatment: prolonged elevation and compression therapy
diabetic lesions
neuropathy- risk factor
-foot inspection and care
-risk of amputation
pressure injury assessment
major risk factors: shearing, friction, moisture, nutritional status (protein deficiency)
assessment tools- norton risk assessment scale, braden scale
musculoskeletal
-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
cardiovascular
-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
arteriosclerosis
narrowing of blood vessels
atherosclerosis
plaque on vessel
respiratory
-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
renal and urological
-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
digestion and nutriton
- 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
nervous system
-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
reproductive system
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
other changes include
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
SPICES
sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, skin breakdown
functional assessment
-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
goals of functional assessment
-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
components of functional assesment
environmental, physical, psychological, socio-economical
activities of daily living
tasks needed for self care (Katz)
instrumental activities of daily living
mobility
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
