lect 4: ch 7 Flashcards
what are the types of assessments included for older adults?
1) physical
2) functional
3) cognition
4) mood
5) balance
what are hindering factors to collecting information for health history?
1) visual and auditory acuity
2) manual dexterity
3) language and health fluency
4) adequacy of translated materials
5) availability of trained interpreter
6) cognitive ability and reading level
what are the data needed for a health history?
1) demographic info
2) past medical Hx
3) current medications/ dietary supplements
4) functional status
5) social Hx
what does social Hx include?
people who will support the patient physically, provide transportation, and are involved in decisions regarding health
living arrangements
resources
which part of social Hx is usually incomplete?
advanced directives
what is the beginning of the assessment of the older adult?
health Hx
what is the end of the assessment?
review of systems (or person’s report of symptoms)
which type of person can speak or make decisions for the older adult with permission?
healthcare proxy or surrogate
what are the instruments used for a physical assessment?
FANCAPES and SPICES
FANCAPES
Fluid
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Social skills
what is the most important part of the lung that needs to be auscultated?
lateral aspects of lower lobes
which two systems are assessed simultaneously?
cardiovascular and pulmonary
what does “activity” assess?
safe ambulation
why are elimination problems more common with older adults who live in institutional systems?
they are dependent on others for assistance to address incontinence
SPICES
Sleep disorders
Problems with eating
Incontinence
Confusion
Evidence of falls
Skin breakdown
tools for functional assessment
1) Katz
2) Lawton
Katz Index
measures ability to perform ADLs on a scale of 0-1
Lawton IADL Scale
determines level of function on a scale of 0-8
how is information acquired for Lawton?
through self-report, proxy, or observation
tools for cognition assessment
1) MMSE (mini mental state examination)
2) CDT
3) Mini-Cog
what does MMSE test?
orientation
short-term memory
attention
calculation ability
language
visuospatial construction
what do the cognition assessment tools mainly screen for?
dementia
how many items are there in MMSE?
30
what is an alternative to MMSE?
SLUMS
what is CDT more effective in screening for?
constructional aphasia (which is an indicator for dementia)
what is CDT not appropriate for?
1) visually impaired patients
2) those who have tremors (Parkinson’s)
3) Hx of stroke
4) severe arthritis
what does CDT test?
manual dexterity and visual acuity
what direction is indicated for CDT?
“draw a clock reading 10 after 11”
a score of 3 or more in CDT represents a cognitive deficit
true
which test is believed to be more sensitive to dementia?
Mini-Cog
what does Mini-Cog test for?
short-term memory and executive function
how long does a Mini-Cog take to administer?
3-5 minutes
what kind of skills does Mini-Cog require?
number fluency
visual and auditory acuity
ability to hold a pencil
experience with analog clocks
directions for a Mini-Cog
1) repeat three unrelated words clearly, one second each
2) draw a clock (as it is in CDT)
3) then recall the three words
what are the tools to assess mood?
1) Geriatric depression scale
2) Centers for Epidemiologic Studies Depression Scale
3) Cornell State for Depression in Dementia
how does untreated depression affect older adults?
further functional impairment, prolonged hospitalizations, decreased quality of life, increased morbidity
how many items is the Geriatric Depression Scale?
30
what does a score of 5 or greater indicate in GDS?
potential major depressive disorder
what makes GDS extremely successful?
it deemphasizes physical complaints, libido, and appetite
tool for comprehensive geriatric assessment
OARS (Older Americans Resources and Services)
range for OARS
6 (most capable)
30 (total disability)
what are the subscales of OARS?
1) social resources
2) economic resources
3) mental health
4) physical health
5) ADLs
tools to assess fall risk, balance, and gait
1) Hendrich II
2) Tinetti Balance and Gait
Hendrich II
Get Up and Go
Tinetti
assesses balance (scale of 16)
things to consider regarding cultural etiquette
1) past experiences in the health care setting
2) ask if there needs to be another person with them during the exam
3) respect communication style
4) do not invade personal space without permission
5) determine general health orientation beforehand
6) ask what they want to be called
7) ask if touch is acceptable
8) ask about their gender
