Ateneo de Zamboanga University

College of Nursing

NCM 114j

Care of the Older Adults

Geriatric Assessment

Name :Jennalyn P. SEvilla Score

Section : BSN III- E

Instruction: Assess an older Adult. It maybe your grandparents , or a family member, or an

elder in the neighborhood.. base on the assessment guide below in term of History,
Physiologic , Functional level be it ADL or IADL and Depression Scale . From the Assessment
below Write at least five (5) Nursing Diagnosis and Five health Teachings ton keep the older
person maintain a satisfactory and Happy life.

Patient Name (Initial):N. S. P.

Age : 60
Ethnic :Bisaya
Religion :Catholic
Marital Statius : Married
Educational Attainment:High school graduate
Support System : Daughters
Source of Income : SSS pension, Farm and fishpond

GERIATRIC ASSESSMENT
History
Present medical History- Current Diagnosis/Chronic Illness
a. Medical History Past medical
Surgeries
treatment
a. Drug History Medications taken
Tobacco alcohol use
b. Nutrition History Type of diet .variety,quantity, use of vitamins, weight, problems
in chewing swallowing ,taste , smell
c. Mental Health Insomnia, mood changes, cognitive changes
d. Social History Living arrangements, financial status, hobbies, socialization,
support system

Geriatric Assessment Workshop D.I. Halbi

 Assessment- Physical Examination
Vital Signs T- 36.3 c
P-82bpm
RR- 16bpm
BP- 90/60 bpm
Integumentary Texture, turgor,Skin problems
Skin Injury, color hydration, nails, hair. Head and neck

Sensory function Hearing, vision, touch, taste and smell

Respiratory Function Assess difficulty and anxieties associated with breathing
Histories of smoking behavior and exposure to environmental
pollutants,Posture , breatlessness, chest sounds
Chest xray, sputum analysis, pulmonary function test
Circulatory Function Chestpain, discomfort, fatigue
ECG
Gastrointestinal Function Oral health assessment, oral health practice, appetite and
changes in appetite, nausea ang vomiting , stomach
discomfort , bowel elimination
Genital urinary function , urinary symptoms, pap smear,, difficulties related the
frequency voluntary flow of urine , for men enlarge prostrate ,
Musculoskeletal function Posture and walking, Gait assistive device
Any report on osteoarthritis , muscle strenght
Reproductive Function She has no abnormal bleeding or discharges and she is
menopause.
Neurological Symptoms She has sleep disturbance, memory loss, weakness, sometimes
numbness and slight difficulty in memory loss and dementia, as
mentioned earlier, many neurologic disorders--weakness,
numbness, poor balance, 
FUNCTIONAL ASSESSMENT
Ability She has the ability to perform self care, self maintenance and
physical abilities like house hold chores and etc.
Disability She cant carry heavy materials and things and easily to get tired.

Activities of Daily Living Index

Katz Index of Independence in Activities of Daily Living

Activities Independence Dependence

Points (1 or 0) (1 Point) NO supervision, (0 Points)
direction or personal WITH supervision, direction,
assistance. personal assistance or total
care.

BATHING (1 POINT) Bathes self (0 POINTS) Need help with

Geriatric Assessment Workshop D.I. Halbi
 Points: _1_________
DRESSING
Points: ___1_______
TOILETING
Points: ___1_______
TRANSFERRING
Points: __1_______
CONTINENCE
Points: ___1_______
FEEDING
Points: ___1_______
TOTAL POINTS: __6______ SCORING: 6 = High (patient independent) 0 = Low (patient
very dependent
Source:
try this: Best Practices in Nursing Care to Older Adults, The Hartford Institute for Geriatric
Nursing, New York University
Geriatric Assessment Workshop
completely or
needs help in bathing only a
single part
of the body such as the back,
genital
area or disabled extremity.
(1 POINT) Get clothes from
closets
and drawers and puts on
clothes and
outer garments complete with
fasteners.
May have help tying shoes.
(1 POINT) Goes to toilet,
gets on and
off, arranges clothes, cleans
genital area
without help.
(1 POINT) Moves in and out
of bed or
chair unassisted. Mechanical
transfer
aids are acceptable
(1 POINT) Exercises
complete self
control over urination and
defecation.
(1 POINT) Gets food from
plate into
mouth without help.
Preparation of food
may be done by another
person.
D.I. Halbi
bathing more than one part of
the
body, getting in or out of the
tub or
shower. Requires total
bathing
(0 POINTS) Needs help with
dressing self or needs to be
completely dressed.
(0 POINTS) Needs help
transferring to the toilet,
cleaning
self or uses bedpan or
commode.
(0 POINTS) Needs help in
moving
from bed to chair or requires
a
complete transfer.
(0 POINTS) Is partially or
totally
incontinent of bowel or
bladder
(0 POINTS) Needs partial or
total
help with feeding or requires
parenteral feeding.
INSTRUMENTAL ACTIVITIES OF DAILY LIVING: Incircle the Number of each scale and
add the Total to get the IADL ability of the Patient

Geriatric Assessment Workshop D.I. Halbi

 LAWTON - BRODY
INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCALE (I.A.D.L)
Scoring: For each category, circle the item description that most closely resembles the
client’s highestlevel (either 0 or 1)
A. Ability to use the Telephone
1. Operates telephone on own initiative-looks up and dials numbers, etc. 1
2. Dials a few well-known numbers 1
3. Answers telephone but does not dial 1
4. Does not use telephone at all 0
B. Shopping
1. Takes care of all shopping needs 1
independently 1
2. Shops independently for small purchases 1
3. Needs to be accompanied on any shopping trip 0
4. Completely unable to shop 0
C. Food Preparation
1. Plans, prepares and serves adequate meals independently 1
2. Prepares adequate meals if supplied with ingredients 0
3. Heats, serves and prepares meals, or prepares meals, or prepares meals 0
but does not maintain adequate diet
4. Needs to have meals prepared and served 0
D. Housekeeping
1. Maintains house alone or with occasional assistance (e.g. "heavy work 1
domestic help")
2. Performs light daily tasks such as dish washing, bed making 1
3. Performs light daily tasks but cannot maintain acceptable level of 1
cleanliness 1
4. Needs help with all home maintenance tasks 0
5. Does not participate in any housekeeping tasks
E. Laundry
1. Does personal laundry completely 1
2. Launders small items-rinses stockings, etc. 1
3. All laundry must be done by others 0
F. Mode of Transportation
1. Travels independently on public transportation or drives own car 1
2. Arranges own travel via taxi, but does not otherwise use 1
publictransportation 1
3. Travels on public transportation whenaccompanied by another 0
4. Travel limited to taxi or automobile withassistance of another 0
5. Does not travel at all
G. Responsibility to Own Medications
1. Is responsible for taking medication in correctdosages at correct time 1
2. Takes responsibility if medication is prepared inadvance in separate 0
dosage 0
3. Is not capable of dispensing own medication
H. Ability to handle Finances
1. Manages financial matters independently(budgets, writes checks, pays 1
rent, bills, goes tobank), collects and keeps track of income
2. Manages day-to-day purchases, but needs helpwith banking, major 1
Geriatric Assessment Workshop
purchases, D.I. Halbi 0
3. Incapable of handling money
TOTAL SCORE
A summary score ranges from 0 (low function, dependent) to 8 (high function,
Geriatric Depression Scale
15-Item Geriatric Depression Scale (GDS-15)
Are you basically satisfied with your life? (yes) or (No)
Have you dropped many of your activities and interests? (yes) or (No)
Do you feel that your life is empty? (yes) or (No)
Do you often get bored? (yes) or (No)
Are you in good spirits most of the time? (yes) or (No)
Are you afraid that something bad is going to happen to you? (yes) or (No)
Do you feel happy most of the time? (yes) or (No)
Do you often feel helpless? (yes) or (No)
Do you prefer to stay at home, rather than go out and do new (yes) or (No)
things?
Do you feel you have more problems with memory than most? (yes) or (No)
Do you feel pretty worthless the way you are now? (yes) or (No)
Do you think it is wonderful to be alive? (yes) or (No)
Do you feel full of energy? (yes) or (No)
Do you feel that your situation is hopeless? (yes) or (No)
Do you think that most people are better off than you are? (yes) or (No)
15-Item GDS score Score
(Score 1 for answers in block capitals: 0-4 yes normal, 5-9 Mild
depression, 10-15 More severe depression)
Dr Yesavage has confirmed that the original scale (from which the calculator has been derived) is in the public domain due to it
being partly the result of US Federal support.
The 15-item (GDS-15) and 4-item (GDS-4) versions of the GDS are good methods of screening for major depression (as is the 10-
item version). The shorter of these (GDS-4) is of limited clinical value in monitoring the severity of the depressive episode (may be
better used to exclude depression).[4] The systematic use of short GDS versions in Primary Care may increase detection rates of
depression among the elderly.[5]

NURSING DIAGNOSIS
1.
2.
3.
4.
5

Health Teachings
1.
2.
3.
4.
5.

Geriatric Assessment Workshop D.I. Halbi

Geriatric Assessment Workshop D.I. Halbi
 1. 1. Assessment of the ElderlyMarc Evans M. Abat, M.D., FPCP, FPCGMInternal Medicine-
Geriatric Medicine
2. 2. Outline• Introduction• Interviewing and History Taking• Physiologic Changes with Aging•
Geriatric Assessment Tools• Examples of Pitfalls That May be Encountered in Physical
Assessment
3. 3. Geriatric Assessment• include non-medical domains• emphasize functional ability and
quality of life,• Rely on interdisciplinary teams• improve care and clinical outcomes – greater
diagnostic accuracy – improved functional and mental status – reduced mortality –
decreased use of nursing homes and acute care hospitals – greater satisfaction with care
4. 4. Geriatric Essentials• Unless corrected, sensory deficits, especially hearing deficits, may
interfere with history- taking.• Many disorders in the elderly manifest solely as functional
decline.
5. 5. • Health care practitioners must often interview caregivers to obtain the history of
functionally dependent elderly patients.• Frail elderly patients with complex conditions (eg,
multiple disorders, use of several drugs) often require assessment by an interdisciplinary
team.
6. 6. Approach to the interview• Asking patients to describe a typical day – establishes a
rapport• Have the patient wear their eyeglasses, dentures, hearing aids, etc.
7. 7. • Interview patient directly as much as possible
8. 8. Medical history• Previous diseases including allergies• Previous surgeries• Past treatment
regimens• Review of old medical records if available• Thorough systems review
9. 9. Drug history • Patient’s drug list • If possible visually inspect all available medications • Do
not overlook – Over-the-counter (OTC) medications – Vitamins and supplements – Herbal
medications – Topical medications • Ability to take the medications
10. 10. Tobacco, alcohol and drug use• Sensitive topic; may need to interview relatives or
caregivers• Unusual preparations of above substances – “nganga” – Snuff or chewed
tabacco – Unusual sources of alcohol
11. 11. Nutrition History• Type, variety, quantity and frequency of feeding• Special diets or diet
fads• Use of vitamins and supplements• Weight changes• Amount of money spent on food•
Accessibility of kitchen and food storage• Problems with chewing, taste and smell
12. 12. Mental Health• Insomnia, changes in sleep patterns, constipation, cognitive dysfunction,
anorexia, weight loss, fatigue, preoccupation with bodily functions, and increased alcohol
consumption• ask about delusions and hallucinations, past mental health care, use of
psychoactive drugs, and recent changes in circumstances• Mood changes or cognitive
changes may indicate depression
13. 13. Social History• Evaluation of living arrangements• Describe typical daily activities –
Hobbies, leisure activities – Socialization activities and contacts, pastoral or spiritual
activities – Driving activities• Caregiver and support systems• Marital status, sexual history,
educational and financial status
14. 14. Physiologic Changes with AgingVital Signs• BP may be overestimated due to stiff
arteries• normal respiratory rate in elderly patients may be as high as 25 breaths/min
15. 15. uneven tanning may be normalSkin• dermis thins by 20% with age, ecchymoses may
occur readily when skin is traumatized• melanocytes are progressively lost
16. 16.  decreased by 50%• Decreased number and function of eccrine and apocrine sweat
glands• Decreased thermoregulation• Linear nail growth
17. 17. Vision• Atrophy of periorbital tissues – May lead to ectropion or entropion• Lacrimal gland
function, tear production and goblet cell production decrease• Atrophy and yellowing of the
conjunctiva• Decreased corneal sensitivity by 50%• Iris becomes more rigid and sluggish
18. 18. ”flashes of light”• Thinning of the retina• All these changes lead to presbyopia – Distance
to focus near objects increases – Decline in static and dynamic visual acuity – Slower

Geriatric Assessment Workshop D.I. Halbi

 adaptation to light – Decline in contrast sensitivity• Vitreous humor and body also shrink –
Separation of the liquid and solid components
19. 19. loss of high- and low- frequency auditionHearing• Atrophy of the external auditory canal•
Drier, more tenacious cerumen• Thicker tympanic membrane• Degenerative changes in the
ossicles• Changes in the inner ear
20. 20. Taste and Smell• Decrease in the lingual papillae• Olfactory detection threshold increase
by 50% and recognition of smells decreases by 15%
21. 21.  shrunken appearance• Loss of teeth• Prominence of neck vesselsHead and Neck•
Loss of fat and connective tissue
22. 22. Respiratory• Decreased cough reflex• Increase in diameter of the trachea and central
bronchi• Calcification of tracheal cartilage• Hypertrophy of mucous glands
23. 23. disappears on deep inspiration• Elevated closing volumes- inability to drain certain lung
areas• respiratory muscle endurance decreases• ↓decreased elastic recoil (decreased lung
elasticity)• chest wall expands and stiffness increases, increasing expiration work of
breathing• Presence of basilar rales in normal patients
24. 24. • Diaphragm may be at a mechanically suboptimal position• Mucociliary clearance slower
and less effective• Forced vital capacity decreases by 0.15-0.3 liters per decade• Forced
expiratory volume in 1 sec decreases by 0.2-0.3 per decade
25. 25. Cardiac• Low-normal to normal heart rate but poor heart rate response with effort• Lower
cardiovascular reserve• ↑vascular stiffness• ↑ventricular stiffness• Early reliance on the
Starling curve to maintain cardiac output
26. 26. • Recovery after exertion more prolonged• Conduction system degeneration• Valvular
degeneration• ↓β-adrenergic responsiveness• ↓baroreceptor sensitivity• ↓SA node
automaticity
27. 27. Gastrointestinal/Hepatic• Oral mucosa thins with age• Small decrease in acinar cells of
salivary glands• subtle decrease in saliva production• Less effective chewing whether or not
teeth are intact• Preserved esophageal motility and sphincter tone
28. 28. • Decreased acid production• Adaptive relaxation is impaired• Moderate atrophy of small
intestine villi• Some lost of myenteric plexi throughout the GI tract• Decreased absorption of
iron, calcium, vitamin D• Decreased lactase levels
29. 29. • Slowed transit and altered contraction of the colon• Increased colonic opioid receptors•
Decreased liver mass• Decreased hepatic blood flow by 10% per decade• Higher lithogenic
index of bile
30. 30. Renal• Decreased renal mass by 25-30%• Renal fibrosis and fatty infiltration• Nephron
loss, preferably those with the longest loops• Diffuse sclerosis of glomeruli
31. 31. • Loss of capillary loops• Thickening of the basement membrane• Decrease in creatinine
clearance by 7.5-10.0 ml per decade• No significant change in serum creatinine due to loss
of muscle mass• Reduction in urine acidification• Impairment of urine dilution• Impaired
ability to retain amino acids and glucose• Vitamin D hydroxylation is impaired.
32. 32. Musculoskeletal• ↓skeletal muscle mass in relation to body weight by 30-40% – Non-
linear – Accelerates with age – Decrease in fiber number and size – Accompanied by altered
innervation
33. 33. • Loss of muscle strength – Up to 60% loss of grip strength – Slower time to peak tension
and slower relaxation – Important role of activity• Decrease in muscle glycolytic enzymes
with age
34. 34. • Decreased bone density• Degenerative joint changes• Joint cartilage changes –
Decrease in tensile strength – Bound water content decreases – Decrease in proteoglycan
units and fragmentation of polymers• Variable resistance to manipulation
35. 35. Hematopoietic System• Decreased bone marrow mass, increased marrow fat• Response
to phlebotomy or hypoxia is slower• WBC generation of free radicals and enzymes is
reduced• Tissue macrophage is decreased

Geriatric Assessment Workshop D.I. Halbi

 36. 36. Endocrine• Increased postprandial glucose levels• Decreased insulin secretion•
Decreased insulin sensitivity• Decreased thyroid volume with fibrosis• Decreased conversion
of T4 to T3• Increased ADH response to osmotic stimuli
37. 37. • GH levels decline with age• Delayed negative feedback with ACTH and cortisol levels•
Decrease in DHEA by 10% per decade
38. 38. Reproductive System• Decrease in ovarian size• Decreased estrogen and progesterone
production; testosterone and androstenedione production also decreased• Atrophy of uterus
and vagina• Reduced vaginal secretions• Involution of breast glandular and ductal tissue•
Ligamentous support of breasts relaxes
39. 39. • Gradual decline but no total loss of male reproductive ability• Decreased sperm
production and quality• Decreased in total, free and available testosterone• Benign prostatic
hyperplasia
40. 40. Nervous System• Decreased brain weight, age- related neuronal loss – Not uniform –
Tends to occur in the largest neurons • Cerebellum: more for the Purkinje cells • Subcortical
regions: locus ceruleus, substantia nigra• Decreased blood flow by 20%• Alteration in
cerebral autoregulation
41. 41. • In general, decreased dendritic density of the remaining neurons – May have a
compensatory increase in some areas• Decrease in myelin in the white matter• Significant
loss in the anterior horn cells• Finger thermal threshold increases with age
Subjective Data:
 Fatigue / weakness
 Dizziness
 Shortness of breath
 Chest pain
 Headache
Objective Data:
 Pale or yellowish skin
 Bleeding / hemorrhage
 Syncope
 Hypotension
 Tachycardia
 Abnormal labs (CBC = decreased RBC and HGB)

Nursing Interventions and Rationales

 Assess for and control obvious signs of bleeding
o External bleeding

Geriatric Assessment Workshop D.I. Halbi

 o Heavy menstruation (>1 pad per hour)
o GI bleed
 
Excessive loss of blood results in decreased oxygenation and poor perfusion.

 
 Perform 12-lead ECG
 
Decreased blood volume causes tachycardia and arrhythmias. Monitor for ST depression and
QT prolongation.

 
 Replace fluid volume per facility protocol
o IV fluids
o Blood transfusion for HGB <8 (per protocol and provider)
 
For blood loss of >40% volume, immediate transfusion is required

 
 Monitor diagnostic testing
o Lab values
o CT scans for possible liver or spleen lacerations
o Fecal occult blood – non-invasive test to determine if there is a potential GI
bleed
 
Lab values to monitor closely:
 HGB (Normal 12-15 g/dL females; 13.5 – 16.5 g/dL males)
 B12 (Normal 2 – 20 ng/mL)

Geriatric Assessment Workshop D.I. Halbi

 Ferritin (Normal 20-300 ng/mL) – the protein that stores iron
 Iron (Normal 50-175 ug/dL)

 
 Monitor oxygen saturation and administer oxygen as necessary
o If SpO2 is <94%, deliver oxygen via nasal cannula at 2L/min and increase as
needed
 
Lack of HGB reduces oxygenation and leads to hypoxia which causes damage to tissues and vital
organs.

 
 Administer medications
 
 Pantoprazole (GI bleed) – helps reduce acid and stop bleeding of peptic ulcers
 IV fluids and electrolytes as necessitated by lab values
 B12 injections or oral supplements – for B12 deficiency
 Erythropoietin is a hormone that may be given to treat anemia caused by chemotherapy
or chronic kidney disease that stimulates production of red blood cells in the bone marrow

 
 Provide nutritional education
o Increase green leafy vegetables
o Incorporate foods high in vitamin C
o Intake of red meat, lamb, poultry and venison as well as fish and shellfish
o Intake of seafood and shellfish
o Limit or avoid intake of foods high in calcium
 

Geriatric Assessment Workshop D.I. Halbi

  Leafy greens such as spinach, kale and chard are high in iron and folate
 Vitamin C assists in the absorption of iron. Good choices include oranges, red peppers
and strawberries
 All meats and most fish and shellfish contain heme iron
 Calcium-rich foods such as raw milk, yogurt, cheese and broccoli are high in calcium,
which binds with iron and prevents absorption

Treatment of anemia in older adults

Treatments vary widely based on anemia type and severity. Caring for seniors
struggling with may include therapies ranging from relatively simple supplementation
and dietary awareness, to more complex approaches. Here are some of the common
anemia treatments:

 Iron supplementation
 Ferrous sulfate
 Ferrous gluconate
 Ferrous fumarate
 Polysaccharide iron
 Iron supplementation note: If patient cannot tolerate ferrous sulfate due to
adverse GI effects, ferrous gluconate is often better tolerated although not absorbed as well.  
 B12 supplementation
 Folate supplementation
 Dietary considerations
 Seafood
 Red meats
 Beans and whole grains
 Vegetables
 Blood transfusion
 Treatment of underlying cause or condition
Help residents increase supplement effectiveness with the following education:
1. Antacids or calcium should not be ingested within four hours of iron supplements.
2. Iron supplements are best taken on an empty stomach, if tolerated.
3. Taking Vitamin C with iron may increase absorption rate.

Geriatric Assessment Workshop D.I. Halbi