Running head: AGING PAPER

Annette Ramos
184375

AGING PAPER

184375

AGING PAPER

Abstract
A complete geriatric assessment was conducted on a 78year old male. This assessment focused
on a basic head to toe assessment, as well as eight major areas. These areas of evaluation
consisted are mental health, communication, activities of daily living (ADLs), economic status,
living home environment, physical health/nutrition, spirituality, and social support. For this
client the impact of aging and coping mechanisms were discussed, as well as a specific plan of
care to help the client with a healthier aging process.

AGING PAPER

Aging Paper
Everyone is aging It is a significant part of life that can never be avoided. This is why
the aging process is so important in healthcare and education. Every day the population is
becoming increasingly older. That is why learning how to effectively manage normal aging
symptoms, as well as diseases that come with increased age is so important. The purpose of this
assignment was to conduct an overall assessment on an elderly individual 65 years of age or
older. The health assessment and history consisted of a basic head to toe assessment as well as
eight major areas. These areas were broken down into: mental health, communication, activities
of daily living (ADLs), economic status, living home environment, physical health/nutrition,
spirituality, and social support.
Health Assessment/History
A health assessment was conducted on a 78year old male. For confidentiality purposes
this patient will be referred to as Mr. X. Mr. X was born on November 26, 1935. He denies any

issues of past medical history associated with his heart, lungs, gastrointestinal tract, and skin. His
past surgical history consist of a tonsillectomy when he was 8 years old and hernia repair surgery
when he was 52. Mr. Xs family history consists of a father who was a heavy smoker and died at
the age of 89 years old. His mother died at 80 years old of unknown causes. Mr. X claims that
his paternal grandmother died at 103 years of age, while his paternal grandfather died at 101
years of age. He did not know the cause of his grand parents death, and was unaware of his
maternal grandparents health history. Mr. X denies any family history of diseases. He is not
currently taking any medications, but does take a multivitamin and Advil when needed for
headaches. His vital signs and basic head to toe physical assessment are listed on table 1-1 in
section A.

AGING PAPER

Mental Health
To assess Mr. Xs mental health The Geriatric Depression Scale (GDS), and the Mental
Status Assessment of Older Adults: The Mini-Cog, were the assessments of choice. The
Geriatric Depression scale is a yes or no questionnaire in which a bolded response indicates
depression (Yesavage, Brink, Rose, Lum, Huang, Adey, & Leirer, 1983). Mr. Xs total score for
this assessment was a six indicating that he may have a mild case of depression. In an
observational study that took place over a period of 1 to 4 years it was concluded that major
depressive episodes plays a big role among the elderly (Lyness, Yu, Tang, Tu, & Conwell,
2009). The study discussed the importance of early detection, where Lyness et al. (2009) stated
that societal costs of depressive conditions in later life are enormous (p. 1), therefore
identifying these risks are necessary in order to provide the best possible interventions (Lyness,
Yu, Tang, Tu, & Conwell, 2009). After assessing with the Mini Cog tool a total score of five
revealed that this client has no positive signs for dementia. During the first part of this
assessment the client was asked to repeat and remember three words light, tree, and flag. The
patient was able to repeat these three words successfully. The client was then asked to draw the
face of a clock showing the time of 11:10. The client was able to draw a perfect clock with the
correct time. When Mr. X was asked to repeat the three words he was asked to memorize, he was
able to repeat them successfully even after distraction from the clock test (Borson, Scanlan,
Chen, & Ganguli, 2003). These assessments can be found in section B. Mr. X denies any family
history of mental illnesses. A study on memory revealed positive results in memory for older
individuals who were involved in more social interactions (Ertel, Glymour, & Berkman, 2008).
Ertel et al. (2008) mentioned that Memory loss is a prominent feature of aging and is associated

AGING PAPER

with substantial declines in quality of life and increased risk of dementia, institutionalization, and
mortality. (p. 1215).
Communication
Assessments for communication are used to measure hearing, vision, and speech. The
Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) is a questionnaire used
to assess how the client feels about their hearing (Ventry & Weinstein, 1983). The interpretations
of the scores are explained on the hearing screening found in appendix C. Mr. Xs score for this
hearing assessment was a two, indicating that he has no hearing handicap. This evaluation can be
found in section C. The client stated that he has no problem with his vision, but does wear
glasses for reading. To assess his vision Mr. X was asked to read the first line of a newspaper,
which he read quickly and successfully with the aid of his reading glasses. His last eye exam was
6 months ago. He mentioned that so far all of his eye exams have been normal, and that he is not
color blind. A study conducted on the importance of out of home activities improving the quality
of life for older individuals, revealed that vision loss is a major culprit in the participation of
most elderly adults (Berger, 2012). Listening to the way the client expressed himself, the way he
read from his newspaper, and evaluating his level of understanding were the most appropriate
ways of assessing the clients speech. Therefore, Mr. Xs speech was clear and appropriate for the
setting. Patients who suffer from a stroke typically may also suffer from communication
problems such as aphasia (Gordon, Ellis-Hill, & Ashburn, 2008). It is with these patients that the
nurse will most likely pick up on altered levels of communication.
Activities of Daily Living (ADLs)
Several different assessment tools were used to assess the clients activities of daily
living. The Katz Index of independence in Activities of Daily Living (ADL) is an assessment

AGING PAPER

tool used to measure six different areas of activity. These activities include: bathing, dressing,
toileting, transferring, continence, and feeding (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963).
The patient must score six points in order to be considered independent. A score below six
means the person may need extra help in certain areas. A very low score (2 or below) represents
severe impairment for the individual (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963). Mr. Xs
total score was a six, which indicates he is completely independent. The Lawton Activities of
Daily Living Scale (IADL) is another assessment tool that was used to assess this clients level
of activity. It is a more in depth assessment used to assess independent levels of activity such as:
ability to use a telephone, shopping, food preparation, housekeeping, laundry, transportation,
medication responsibility, and financial handling (Lawton & Brody, 1969). The score ranges
from a low zero to a high eight (Lawton & Brody, 1969). A Falls Efficacy Scale was used to
determine the clients fear of falling (Tinetti, Richman, & Powell, 1990), and the Tinetti balance
and gait evaluation was also conducted to test Mr. Xs balance and gait (GeriU, 2011). These
assessments can be located in section D. A research study conducted on ADLs and IADLs
linked an unhealthy diet as the most prevalent lifestyle risk factor, regardless of disability
level, (Kim, Sagar, Adams & Whellan, 2009, p. 444).
Economic Status
During the interview the client was asked certain questions regarding his economical
status. He mentioned that he receives a check from social security, and from his pension. He has
a savings and checking account. Mr. X does have a living will, and his daughter is his durable
power of attorney. He plans on staying with his daughter for as long as he is independent. He
mentioned that if he should ever become ill he would not mind being placed in an assisted living
or skilled facility, However the decision would have to be made by his daughter. When

AGING PAPER

discussing end of life care with Mr. X he stated I do not want to be bothered, if its my time to
go I just want to go, I do not want any tubes or anythingMy daughter knows all of this
already. Durbin et al. (2010) states that Completing an advanced directive is significant
because it provides a person with the potential to give input into end-of-life decisions (p.234).
Living Home Environment
Mr. X lives in a partial apartment that was built as an addition to his daughters home.
The addition that Mr. X lives in is set up like an open concept studio apartment. It contains a
bedroom, living room, bathroom, and kitchen in one open floor plan. The clients apartment did
not contain any stairs. His toilet seat was raised, and he did contain grab bars. His shower was an
easy step in shower, which contained a bath mat, shower seat, or grab bars. Because Mr. X is an
artist his apartment was filled with many different sculptures and paintings that gave the
impression of an organized yet cluttered room. Mr. Xs apartment contained night- lights
throughout different areas including his bathroom. The floors were a bit narrow because of all his
sculptures and art work, but they were free of cords, lose rugs, and without any pets. Mr. X had
one smoke detector in his kitchen that contained brand new batteries, and was in good working
condition. The client mentioned that he did have a cell phone, however he stated that he does not
use it because he is afraid charging it will cause a fire. He mentioned that he prefers to use his
families phones whenever necessary, and mostly to call his brother. Since Mr. X does not use his
phone he does not have any preprogrammed emergency telephone numbers. Mr. X has one large
floor heater that warms up his whole apartment. The apartments heat was appropriate for the
setting. He mentioned that he checks the heaters wire every 15 minutes because he does not want
the wire to catch on fire. When the client was asked if there was any reason for his fear of
electrical cords catching on fire he admitted that when he was a younger adult he almost set his

AGING PAPER

home on fire when he forgot to unplug an iron. He admitted that ever since this incident he has
always been cautious with plugged in devices. When Mr. X was asked if his hot water was set
below 120 degrees Fahrenheit his response was I dont know. This question was later brought
to the attention of Mr. Xs daughter in which she mentioned that it was set to a temperature
below 120 degrees Fahrenheit. If there were ever an emergency he mentions that he can rely on
his family to help him, in which there is typically at least one other person in the home. Mr. X
lives in a safe neighborhood, and has adequate door locks. He also has a neighbor right next door
that he is friendly with, and would feel comfortable asking for help if there were ever an
emergency (Tabloski, 2014, p. 57).
Physical Health/Nutrition
When this client was asked what his typical diet consists of he revealed that he is not the
healthiest eater. He stated that his typical breakfast is toast with black coffee, that he rarely eats
lunch, and that his dinners are usually pasta with meatballs, or sweet potatoes. Mr. X stated that
he does not like vegetables too much, and that he hates drinking water, and prefers to drink apple
juice instead. When Mr. X was asked how many cups of water he drinks a day, he stated Ill
have maybe one cup if Im feeling really thirsty. Mr. X also mentioned that he loves sweets.
Several different assessment tools were used to evaluate Mr. Xs physical health and nutrition.
The tools used were: Assessing Nutrition in Older Adults (Guigoz, Vellas, & Garry, 1994), Oral
Health Assessment of Older Adults (Kayser-Jones, Bird, Paul, Long, & Schell, 1995), The
Epworth Sleepiness Scale (Johns, 1991), The Pittsburgh Sleep Quality Index (Buysse, Reynolds,
Monk, Berman, & Kupfer, 1989), and the Urinary Incontinence Assessment (Uebersax, Wyman,
Shumaker, McClish, Fantl, & the Continence Program for Women Research Group, 1995).
These assessments can be found under section E.

10

AGING PAPER

Spirituality
To assess this clients spirituality the Assessment of Spirituality in Older Adults: FICA
Spiritual History Tool was the evaluation of choice (Puchalski, 2006). After gathering

information from this assessment it was revealed that Mr. X is not apart of any religious groups
or communities, but feels that he is a very spiritual person. He mentioned that he believes in god,
but has many other different beliefs as well. Mr. X mentioned that he has faith and that it is his
faith that helps him believe that everything eventually falls into place at the end of the day. The
spiritual assessment can be located under section F.
Social Support
Mr. X is a retired elementary school janitor. His past marital status consists of three
marriages that all ended in divorce. He has been single for over thirty years. The client lives with
his family in an attached addition to his daughters house. His family is made up of his daughter,
son in law, and teenage granddaughter. He also has two grandsons, however they do not live in
the same household. Mr. Xs family genogram can be located on section G.
Impact of Aging & Coping Mechanisms
Mr. X stated that aging has significantly impacted the way he moves his body. He stated
I am no where near as fast as I used to be, and that is probably one of the most upsetting things
aging has caused for me. Mr. X stated I know Im not as young, fast, and physically fit as I
once was. He mentioned that his way of coping with this is by exercising, and moving around
as much as he can tolerate. Another way Mr. X copes is by keeping himself occupied with
reading and his love for painting. The client realizes that his ways of coping are all positive. To
Mr. X successful aging is anyone who still has the ability to live independently. In The Life
Course and the Stress Process: Some Conceptual Comparisons, the author talks about the

11

AGING PAPER

transitions of later life causing stress on the person (Pearlin, 2010). Things such as the death of a
spouse can cause transitional stress in older adults which can make coping among the elderly
much more difficult (Pearlin, 2010).
Problem Areas
There were two main problem areas that were identified in Mr. Xs health assessment.
These problems were identified in his living home environment, and in his nutritional health
evaluation. During the home assessment it was noticed that Mr. Xs home was cluttered with art
work, sculptures, and paintings. This environment left small walking paths for ambulation. In a
recent study on fall prevention it was mentioned that falls are the leading cause of injury
[Centers for Disease Control and Prevention (as cited in Costello & Edelstein, 2008)]. Older
adults (ages 65 and older) who happen to have a fall are at an increased risk of premature death
(Costello & Edelstein, 2008, p. 1135). During the home evaluation the client also mentioned that
he does not use his cell phone because he fears charging it will cause the wire to catch on fire.
This information was not only odd, but unsafe because not having a telephone can be a risk to
the client should a potential emergency arise. A study on specific phobias in older adults
mentioned that phobic disorders are common in people ages 60 and up [Ritchie et al. diary (as
cited in Pachana, Woodward, & Byrne, 2007)]. The final problem area was noted in the clients
physical health/nutrition assessment. Mr. X revealed that he does not enjoy eating vegetables, he
does not drink enough water, he typically skips eating lunch, and he prefers to eat sweets. This
level of poor nutrition can also be very risky to the aging client.
Nursing Diagnosis
Nursing Diagnosis for Problem one

AGING PAPER

12

Risk for falls related to poor environmental safety as evidenced by cluttered, small
ambulatory paths, is the first nursing diagnosis to address the living home environmental
problem in Mr. Xs home (Ralph & Taylor, 2011). The goals will be to teach the client and
family members the importance of household safety, identify the potential fall hazards, and to
make the necessary changes for a safer home (Ralph & Taylor, 2011). These goals are also the
best interventions in helping the client with a safer and more comfortable home. The first
intervention on teaching the client and family about the importance of household safety is
important because it addresses the problem and provides a better understanding of what can
occur if the problem is not resolved. Identifying the fall hazards is a great way for caregivers to
create awareness of the risks (Ralph & Taylor, 2011, p. 606), and making those necessary
changes is what will prevent potential accidents from occurring (Ralph & Taylor, 2011).
Anxiety related to environmental phobia as evidenced by fear of plugged in electrical
cords is the second nursing diagnosis that addresses Mr. Xs living home environmental issues
(Ralph & Taylor, 2011). The main goal for this client is to identify the main cause or stressor that
brings on his phobic behavior (Ralph & Taylor, 2011). This goal can also serve as an important
intervention. Identifying the main cause for the clients phobic behavior is needed to understand
the reason behind the clients behavior, and will help in implementing a better plan of care
(Ralph & Taylor, 2011). In this case Mr. X experienced a traumatic event where he almost lost
his home when forgetting about a plugged in device that led to a fire. Reassuring the client can
be the next intervention (Ralph & Taylor, 2011). Reassuring the client that he has a valid reason
for his fear, but that it is most likely due to his traumatic past experience will help in reducing the
clients level of anxiety. It can also help in building trust between the nurse and patient. This
intervention of reassuring the client also leads to the final intervention of encouraging the client.

AGING PAPER

13

Encouraging Mr. X to not avoid his fear but rather to face it helps the patient learn that fear can
be faced and managed (Ralph & Taylor, 2011, p.658).
Nursing Diagnosis for Problem two
Risk for electrolyte imbalance related to poor fluid intake is the first nursing diagnosis
that addresses the clients second issue related to his nutritional health (Ralph & Taylor, 2011).
The major goal for this client would be to increase his daily intake of water. The recommended
daily intake of water for men is 13 cups a day (Tabloski, 2014). This does not include alcohol or
caffeine beverages (Tabloski, 2014). As part of this clients plan of care the first intervention
would be to educate the patient on the importance of proper hydration. Dehydration among the
elderly can bring on many risk factors such as postural hypotension, falls, electrolyte imbalance,
constipation, and even death (Tabloski, 2014). Talking with the client about this will help him
understand his potential risk factors. Doing this also helps the nurse implement a better care plan
in order to help the patient achieve his goal. The nurse can also discuss ways to increase the
clients intake of water. Adding different fruits to regular drinking water is a wonderful way to
help increase the water intake for patients who are not too fond of plain water (Harvard School
of Public Health, 2014). This intervention helps flavor the water, and adds more nutrients to the
water which is beneficial to the client.
Risk for imbalanced nutrition: less than body requirements related to unhealthy diet is the
second nursing diagnosis that addresses Mr. Xs second problem area of his nutritional health
(Ralph & Taylor, 2011). The goals for this patient will be to find out the clients healthiest food
preferences, and to consume the recommended amount of necessary healthy foods. Encouraging
the client to talk about their reasons for not wanting to eat more nutritious foods is helpful in
identifying the main problem areas (Ralph & Taylor, 2011). For example, if the patient states

AGING PAPER

14

that they cannot taste the food properly an oral assessment may be necessary. This can rule out
certain medical conditions such as Candidiasis or fungal infection of the mouth which may be
inhibiting the clients sense of taste (Ignatavicius & Workman, 2010). The problem may be as
simple as the patient may just need better oral care which may also impair taste sensation.
Another helpful intervention would be in finding out the clients food preferences. By doing this
it will help to enhance the clients appetite. One other possibility is to give the elderly patient
more food options and variety by providing them with a food guide pyramid or MyPlate for older
adults (Tabloski, 2011). This would be another great method in helping the elderly client
consume more nutritious foods that may appeal to their specific taste (Tabloski, 2011).
Conclusion
Aging is a significant part of life, and that is because every day the population is
becoming significantly older. When this assessment was first started it was thought that the client
being assessed would have no significant plan of care, because of the fact the patient is so
healthy and independent. However, it turned out to be quite a surprise to see the potential hazards
this client was facing. The interventions that were implemented provided a sigh of relief not only
to the client, but also to the clients family members. This is why learning how to effectively
manage normal aging symptoms, as well as diseases that come with increased age is so very
important.

15

AGING PAPER

References
Berger, S., (2012). Is My World Getting Smaller? The Challenges of Living with Vision Loss.
CEU Article,
Borson, S., Scanlan, J.M., Chen, P., & Ganguli, M. (2003). The Mini-Cog as a screen for
dementia: Validation in a population-based sample. JAGS, 51(10), 1451-1454.
Buysse, D.J., Reynolds III, C.F., Monk, T.H., Bernamn, S.R., & Kupfer, D.J. (1989). The
Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.
Journal of Psychiatric Research, 28(2), 193-213.

Costello, E., & Edelstein, J.E., (2008). Update on falls prevention for community-dwelling older
adults: Review of single and multifactorial intervention programs. Journal of Rehabilitaiton
Research & Development, 1135-1152.
Durbin, C.R., Fish, A.F., Bachman, J.A., & Smith, K.V., (2010). Systematic Review of
Educational Interventions for Improving Advance Directive Competion. Journal of Nursing
Scholarship, 234-241.
Ertel K.A., Glymour M., & Berkman L.F. (2008). Effect of social integration on preserving
memory function in a nationally representative US elderly population. American Journal of
Public Health, 1215-1220.
Gordon, C., Ellis-Hill, C., & Ashburn, A., (2008). The use of conversational analysis: nursepatient interaction in communication disability after stroke. Journal of Advanced Nursing,
544-553.
Guigox, Y., Vellas, B., & Garry, P.J. (1994). Mini Nutritional Assessment: A practical
assessment tool for grading the nutritional state of elderly patient. Facts and Research in
Gerontology, 4 (Suppl.2), 15-59.

AGING PAPER

16

Healthy Drinks, The Nutrition Source (2014). Harvard School of Public Health.
http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/
Ignatavicius, D.D., & Workman, M. L. (2010). Medical-surgical nursing: Patient- centered
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness
scale. Sleep, 14, 540-545.
Katz, S., Ford, A.B., Moskowitz, R.W., Jacson, B.A., & Jaffe, M.W. (1963). Studies of illness in
the aged: The index of ADL: A standardized measure of biological and psychosocial
function. JAMA, 185(12), 914-919.
Kayser-Jones,J., Bird, W.F., Paul, S.M., Long, L., & Schell, E.S. (1995). An instrument to assess
the oral health status of nursing home residents. The Gerontologist, 35(6), 814-824.
Kim, D.H., Sagar, U.N., Adams, S., & Whellan, D.J., (2009). Lifestyle Risk Factors and
Utilization of Preventive Services in Disabled Elderly Adults in the Community. J
Community Health, 440-448.
Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and
instrumental activities of daily living. The Gerontologist, 9(3), 179-186.
Lyness, J.M., Yu, Q., Tang, W., Tu, X., & Conwell, Y., (2009). Risks for Depression Onset in
Primary Care Elderly Patients: Potential Targets for Prevention Interventions. The American
Journal of Psychiatry, 1375-1383.
Pachana, N.A., Woodward, R.M., & Byrne, G.J.A., (2007). Treatment of specific phobia in older
adults. Original Research. 469-476.
Pearlin, L.I., (2010). The Life Course and the Stress Proces: Some Conceptual Comparisons. The
Journals of Gerontology Biological Sciences & Medical Sciences. 207-215.

AGING PAPER

17

Puchalski, C., & Romer, A.L. (2000). Taking a spiritual history allows clinicians to understand
patients more fully. Journal of Palliative Medicine, 3(1), 129-137.
Tabloski, P. (2009). Gerontological Nursing. Upper Saddle River, NJ: Pearson-Prentice Hall
Tinetti Balance And Gait Evaluation,. (2011). The Online Geriatric University.
http://www.geriu.org/uploads/applications/Tinetti/tinetti.htm
Tinetti, M.E., Richman, D., & Powel, L. (1990). Falls efficacy as a measure of fear of falling.
Journal of Gerontology, 45(6), P239-P243. Doi:10.1093/geronj/45.6P239.
Uebersax, J.S., Wyman, J.F., Shumaker, S.A., McClish, D.K., Fantl, J.A., & the Continence
Program for Women Research Group. (1995). Short forms to assess life quality and symptom
distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the
urogenital Distress Inventory. Neurology and Urodynamics, 14 (2), 131-139.
Ventry, I.M., & Weinstein, B.E. (1983). Identification of elderly people with hearing problems.
ASHA, 25, 37-42.
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B., & Leirer, V.O.
(1983). Development and validation of a geriatiric depression screening cale: A preliminary
report. Journal of Psychiatric Research, 17, 37-49.