MODULE 4 (PPT) : ASSESSMENT AND  Considering change in living situation

CARE OF THE ELDERLY II. Domains of Comprehensive Geriatric Assessment

1. Function and Ability, Fall Risk
Assessment Instrumental Activities of Daily Living
 Health History KATZ Index of Activities of Daily Living
Complex and time consuming. KATZ Index of ADL
Information processing slows in aging (allow Why:
enough time).  Normal aging changes and health problems
Assessment takes more than 1 session. frequently show themselves as declines in the
 Presenting Problem functional status of older adults.
Assess client systematically depending upon  Decline may place the older adult on a spiral of
presenting problem. iatrogenesis leading to further health problems.
Manifestations of illness change with age.  One of the best ways to evaluate the health status
 Lifestyle of older adults is through functional assessment
Emphasis on functional changes rather than which provides objective data that may indicate
structural changes. future decline or improvement in health status,
Functional assessment is an attempt to measure allowing the nurse to intervene appropriately.
performance in physical health and functioning
Best Tool:
with current ability.
 The Katz Index of Independence in Activities of
Have person demonstrate ADL whenever
Daily Living, commonly referred to as the Katz ADL,
possible.
is the most appropriate instrument to assess
 Use of Medications
functional status as a measurement of the client’s
Inquire about drug prescriptions.
ability to perform activities of daily living
Determine client’s understanding of purpose of
independently.
drugs, treatment regimen, and side effect.
 Clinicians typically use the tool to detect problems
Determine if client is taking prescribed drugs.
in performing activities of daily living and to plan
Inquire about use of non-prescription drugs.
care accordingly.
 Nutrition
 The Index ranks adequacy of performance in the six
Obtain food intake profile.
functions of bathing, dressing, toileting,
Determine if client has difficulty ingesting food,
transferring, continence, and feeding.
foods client is unable to eat.
 Clients are scored yes/no for independence in each
Determine ability of client to purchase and
of the six functions.
prepare food.
 A score of 6 indicates full function, 4 indicates
 Past Medical History
moderate impairment, and 2 or less indicates
Determine presence of chronic diseases.
severe functional impairment.
Inquire about previous illness & surgeries.
Target Population:
Comprehensive Geriatric Assessment  The instrument is most effectively used among
 Identify medical, psychosocial and functional older adults in a variety of care settings, when
limitations of a frail older person in order to baseline measurements, taken when the client is
develop a coordinated plan to maximize over-all well, are compared to periodic or subsequent
health with aging. measures.
I. Target Validity and Reliability
 Age  In the thirty-five years since the instrument has
 Multiple medical disorders been developed, it has been modified and
 Psychosocial disorders simplified and different approaches to scoring have
 Specific geriatric conditions been used.
 Previous or high healthcare utilization
 However, it has consistently demonstrated its utility Seconds Rating
in evaluating functional status in the elderly < 10 Freely mobile
population. < 20 Mostly independent
 Although no formal reliability and validity reports 20 - 29 Variable mobility
> 30 Assisted mobility
could be found in the literature, the tool is used
extensively as a flag signaling functional capabilities Follow – up Assessment
of older adults in clinical and home environments. In the follow-up assessment, ask the person to:
Strengths and Limitations:  Sit.
 The Katz ADL Index assesses basic activities of daily  Stand without using their arms for support.
living.  Close their eyes for a few seconds, while standing in
 It does not assess more advanced activities of daily place.
living.  Stand with eyes closed, while you push gently on
 Katz developed another scale for instrumental his or her sternum.
activities of daily living such as heavy housework,  Walk a short distance and come to a complete stop.
shopping, managing finances andtelephoning.  Turn around and return to the chair.
 Although the Katz ADL Index is sensitive to changes  Sit in the chair without using their arms for support.
in declining health status, it is limited in its ability to
History of fall prior to 12 months, acute fall, difficulty
measure small increments of change seen in the with walking/balance.
rehabilitation of older adults.
2. Disease Severity and Comorbidity, Polypharmacy
 A full comprehensive geriatric assessment should
Visual impairment
follow when appropriate.
Hearing impairment
 The Katz ADL Index is very useful in creating a
Malnutrition / Obesity
common language about patient function for all
Mini Nutritional Assessment
practitioners involved in overall care planning and
 It is a validated nutrition screening and assessment
discharge planning.
tool that can identify geriatric patients age 65 and
Get Up and Go Test
above who are malnourished or at risk of
 The “Get Up and Go Test” is an assessment that malnutrition.
should be conducted as part of a routine evaluation
when dealing with older persons.
 Its purpose is to detect “fallers” and to identify
those who need evaluation.
 The staff should be trained to perform the “Get Up
and Go Test” at check-in and query those with gait
or balance problems for falls.
 Only valid in patients not using an assistive device.
Initial Check
All older persons who report a single fall should be
observed as they:
 From a sitting position, stand without using their
arms for support.
 Walk 10 feet, turn, and return to the chair.
 Sit back in the chair without using their arms for
support.
 Individuals who have difficulty completing the
above in less than 10 seconds or demonstrate
unsteadiness performing this test require further
assessment.
 Originally comprised of 18 questions, the current  The shortened form (GDS-S) is comprised of 15
MNA now consists of 6 questions and streamlines items chosen from the Geriatric Depression Scale-
the screening process. Long Form (GDS-L).
 The current MNA retains the validity and accuracy  These 15 items were chosen because of their high
of the original MNA in identifying older adults who correlation with depressive symptoms in previous
are malnourished or at risk of malnutrition. validation studies.
3. Mental Health and Cognition  Of the 15 items, 10 indicate the presence of
Cognitive Assessment (3 item recall) depression when answered positively while the
Mini-Cog Screening Test other 5 are indicative of depression when answered
 It is a 3-minute instrument that can increase negatively.
detection of cognitive impairment in older adults.  This form can be completed in approximately 5 to 7
 It can be used effectively after brief training in both minutes, making it ideal for people who are easily
healthcare and community settings. fatigued or are limited in their ability to concentrate
 It consists of two components, a 3-item recall test for longer periods of time.
for memory and a simply scored clock drawing test. 4. Support Networks and Needs
 As a screening test, however, it does not substitute Environment assessment
for a complete diagnostic workup. Spirituality
Geriatric Depression Scale (how often one feels sad or Advance directive
depressed)  DNR
Geriatric Depression Scale (GDS)  Durable power of attorney
 It is a self-report measure of depression in older  Living will
adults.  Health care proxy
 Users respond in a “Yes/No” format. III. Laboratory and Diagnostic Tests
 The GDS was originally developed as a 30-item  Laboratory tests are indicated according to
instrument. symptoms of individual client.
 Since this version proved both time-consuming and  Interpret laboratory tests with aging client.
difficult for some patients to complete, a 15-item
IV. Nursing Diagnosis
version was developed.
 Activity intolerance
 Alterations in bowel elimination: constipation
 Alteration in comfort: acute/chronic pain
 Anxiety
 Impaired verbal communication
 Fluid volume deficit
 Risk for infection
 Knowledge deficit
 Impaired physical mobility
 Alteration in nutrition: LBR
 Alteration in respiratory function: ineffective airway
clearance
 Self-care deficits: feeding
 Sensory perceptual alterations
 Sleep pattern disturbance
 Sensory-perceptual alterations: visual r/t aging
V. Planning and Implementation
 Maximum independence in self-care activities.
 Client will maintain normal bowel & bladder
elimination patterns.
 Client will maintain ability to communicate.
 Client will maintain positive self-concept.
 Client will remain free from injury.
 Optimal cognitive functioning will be maintained.
 Client will maintain adequate nutritional status &
fluid balance.
 Client will maintain social contacts.
 Client will follow treatment regimens as prescribed