Lecture 4

Question 1

What does a score of 6 mean on KATZ ADL tool?

Answer 1

6- full function

Question 2

What does score of 4 mean on Katz ADL tool?

Answer 2

4- moderate impairment

Question 3

What does score of 2 mean on katz ADL tool?

Answer 3

2- severe impairment

Question 4

Katz ADL tool

Answer 4

•	ADLs to get through day to day
o	Bathing
o	Dressing
o	Toileting
o	Transferring (bed to chair, etc.)
o	Feeding
o	Continent?
•	Can do? – 1 pt
•	Do with supervision? – 0 pt

Question 5

Lawton ADL tool

Answer 5

o Can they live on their own?
o Or can only live at home while kids are at work?
• IADLs
o Can they prepare food?
o How do they travel?
o Medication compliance?
o Handle finances ok?
o Housekeeping?
• Scale is 1 to 5 for men, 1 to 8 for women
o More appropriate for older generation (not for this generation, though)

Question 6

• Functional stages of Alzheimer’s Dementia

7 stages

Answer 6

1. Normal adult
2. Normal older adult
3. Early dementia
4. Mild dementia
5. Moderate dementia
6. Moderately severe dementia
7. Severe dementia

Question 7

6. Moderately severe dementia

Answer 7

a. Caregiver strain increases
b. Aggression and violence increases
i. Just aware enough to be scared
ii. End up blaming someone else
iii. No point in arguing or raising your voice
iv. Even tone, rewording statements, shorter sentences, slower speaking, etc.

Question 8

7. Severe dementia

Answer 8

a. Usually contract an infection (often pneumonia)

Question 9

Cognition Tools

MMSE: Screens for Cognitive impairment

Mini-Cog: *Screens for Cognitive impairment

Answer 9

Clock Drawing Test: Constructional Apraxia - An indicator of Alzheimer’s Disease
o You provide the circle, nothing else
o Pts have to know how to fill in the circle and show a particular time
 Higher predictor of dementia: 11:10
 Are numbers and hands basically correct?
• Remember three random words in sequence
o Provide words before clock drawing test, then ask after the test
• ONLY INDICATIONS BUT NOT DIAGNOSTIC
o Follow up: send to provider who can diagnose

Question 10

Mood Assessment Tool

Answer 10

Geriatric Depression Scale (GDS): Assess satisfaction with life beyond physical health
MAY LEAD to increase functional decline, and health problems.
• Know how to run, score and interpret the tools
• Ask the patient not the caregiver
o Caregiving family really wants pt to get better
o Even if patient can only nod or shake head
o As long as it’s accurate
• Loss of independence major driver of depression
o Esp. for highly acute patients in LTC
• Bold answers -> 1 pt (indicates depression)
• Score of 5 or up: suggestive of depression
• Next step after identifying depression:
o Signs of physical decline?

Question 11

Safety of the Older Adult

Answer 11

Safe environment: Allows older person to live without fear of attack, accident or imposed interference
Cognitive decline may

Question 12

What makes a patient more susceptible to crime?

Answer 12

• live alone
• memory impairments
• loneliness

Question 13

Fraud: Fraudulent Schemes Against Elders

Answer 13

o	Do not recognize fraud by 
	Phone callers
	Theft
•	Ppl claim to have been sent to repair medical equipment
•	Take med equipment and never return
	Overbilling by medical providers
	Sociopaths in their religious congregations
•	‘Sob story’ – take \$\$$ - disappear
	Family members or even caregivers
o	Think: A&O x4 (can they reason well?)

Question 14

o Fever: a one-degree change from baseline may be significant in older adults

Answer 14

 They may have a lower baseline

• If baseline 98 -> 99 is a problem!!!

Question 15

o Hypothermia: core temperature < 95 degrees F

Answer 15

	90% of hyperthermia deaths in the elderly
•	GOAL: Temp >97º 
•	Definition: body temps 95° or less
•	Rewarming techniques:
o	Slow, focus on core
o	Older may become hypothermic more quickly
	Lack of perception
	Lack of shiver reflex, etc.
	Risks:
•	Malnutrition
o	Insufficient intake to maintain thermal integrity
•	Hypothyroidism, adrenal insufficiency
•	Impaired circulation
•	Alcohol use
o	Lowers metabolic rate
o	They can pass out in the cold and die while unconscious

Question 16

 Example of application question: If power goes out, who do you assess first?

Answer 16

• Alcoholic
• Impaired circulation
• Diabetes
• Adrenal/thyroid dysfunction
• Inadequate supervision
• Sedative/antidepressant use

Question 17

o Hyperthermia: Ambient temperature > 90 degrees F

Answer 17

•	Heat fatigue
o	Pale, sweaty, tachycardic, but normal temp
•	Heat exhaustion
o	Muscle cramping
	Dehydration
o	Cool and clammy, tachycardic
o	Nausea
o	Normal/slightly elevated temp
o	Confusion in severe heat exhaustion / heat stroke
•	Heat stroke
o	MEDICAL EMERGENCY – potentially FATAL
o	High mortality rate among elderly
o	Flushed, hot and dry
o	First and most important action: Dial 911
	Always call in cases of doubt
	Better to send back than risk death
o	Hypotensive
o	Hyperthermic 
	If 104°, cool
	Move to cool house
	Place cold cloths on pulse points
	Get them below 102°
o	Prevention
	Drink at least 2 l water / day
	Staying indoors
	Avoiding exercise
	Wear loose, light colored clothing
•	‘Natural fibers’ – ((I don’t buy this, cotton is awful in the heat, maybe linen))
	Assess meds for hyperthermia risks
	Avoid alcohol
	Watch out for humidity
•	Evaporative cooling doesn’t work in humid conditions