Assessment of

the Older Adult

 SYSTEMAT IC GERIATRIC ASSESSMENT
❖Critical use of Senses
• The nurses’ assessment of older adults requires the ability to actively listen as well as to use all
other senses to gather data.
❖Need experience and expertise
• This often draws upon experience and expertise gained over time in working with the older
population.
• An inexperienced nurse is often frustrated by the length of time needed for the geriatric
assessment, and the inability of some older adults to keep focused on providing the necessary
information. *
• This assessment will probably take a long time, and it may be necessary to consistently encourage
the client to focus on answering the questions. *
• Written forms and checklists can help the nurse to keep the client more focused.
SYSTEMAT IC GERIATRIC ASSESSMENT

❖Provision of appropriate environment *

• Environmental adaptations are usually necessary to
compensate for the older adult’s physiological and
psychological changes of aging.
• Modifications to the physical environment start with a room
that is comfortably warm to the client and not exposing the
client any more than is necessary. *
• Amella (2004) states that the “key to providing appropriate
treatment to older adults is going beyond the usual history
and physical parameters to examine mental, functional,
nutritional and social-support status.”
 SYSTEMAT IC GERIATRIC ASSESSMENT
T • The room should be adequately bright but with indirect lighting to compensate for diminished visual acuity.
• Fluorescent lighting and window glare should be avoided.
• Straight-backed chairs with arms that are cushioned for comfort should be utilized, making sure that the client’s height
I allows for ease in rising from them.
• The examination table should be low and well padded to protect from discomfort.

P • The head of the examination table should rise up, as some older adults may have difficulty lying flat for any amount of
time.
• There should be adequate space in the examination room to accommodate mobility aides.

S • The room should be free from distraction and background noises.

• It is important to take into consideration the energy level of the older adult and conduct the physical examination at
the individual’s own pace.
• Minimize skin exposure of the older adult to prevent chilling. These factors may indicate the need to conduct the
examination over more than one session.
• It is helpful to organize the examination to reduce the changes in body positions and conserve the client’s energy. *
SYSTEMAT IC GERIATRIC ASSESSMENT
*The following are various techniques need to be utilized to assess each individual
adequately:
• *The examiner must spend some extra time establishing a nonthreatening relationship. T
• As a sign of respect, older adults should be addressed by their last name and title. The
first name should be used only if invited to do so.
I
• The nurse must allow the older client enough time to respond to questions.
• The nurse should speak facing the client and use commonly accepted wording. P
• Allowing hearing-impaired clients to see the nurse’s entire face and body so that they
may detect lip reading and body language may be helpful. *
S
• For clients with visual deficits, nurses must make sure that the clients have their glasses
on and plan to use visual cues as needed.
• Family members can provide important information, but the examiner needs to focus on
the client.
SYSTEMAT IC GERIATRIC ASSESSMENT
• *Geriatric interdisciplinary teams (GITs)—made up of physicians, nurses, physical therapists, occupational
therapists, recreational therapists, social workers, psychologists, and nursing assistants—make assessment
more efficient by assigning components of the assessment to the most qualified member of the team.
• After completing assigned components of the assessment, GIT members gather together to plan care for the older adult, which is
generally more comprehensive and effective than when individual team members work alone

• Geriatric interdisciplinary team care has been effective in managing the complex syndromes experienced by
chronically ill and frail older adults with multiple co-morbidities, because such care requires skills that are
not possessed by any one professional.
• Positive outcomes of geriatric teams have been revealed in multiple studies, including one by Li, Porter, Lam,
and Jassal (2007).
• These researchers found that a team approach to care delivery resulted in quicker hospital discharge and improved functional status.

• The Institute of Medicine (IOM) of the National Academy (2001), in attempts to reduce medical errors and
improve patient outcomes, challenges all health care professionals to recognize the need for effective
interdisciplinary team care for multiple patient populations.
SYSTEMAT IC GERIATRIC ASSESSMENT
❖*Pay close attention to culturally appropriate behaviors
• It is important to determine how the older adult would like to be addressed and the language that they
are most comfortable speaking.
• If the older adult speaks a language foreign to the nurse, the client should be questioned as to whether
or not an interpreter is desired or whether a family member would like to communicate the client’s
history.
• Attention should also be paid to the older adult’s comfort with the amount of personal space, eye
contact, and physical gestures of the health care provider.
• The relationship of the nurse to the client requires recognition of and sensitivity to cultural differences,
because some cultural groups definitions of health and illness may differ from the examiners.
• These same cultural groups may also have their own health practices that are thought to promote
health and cure illness within the group.
• All nurses should make efforts to modify health care according to the client’s cultural beliefs in order to
provide culturally competent care.
 SYSTEMAT IC GERIATRIC ASSESSMENT
❖Remember that some of the standardized assessment tools
• Be cautious about interpreting a tool that has not been formally translated, as the meanings of many words
change by cultural background.
• During the assessment, it is necessary to determine the decision maker in the family and respect the client and
families wishes in sharing information.
• In some cultural backgrounds, older adults are prevented from hearing about their diagnoses, and family
members are given this information.
• In addition, some diseases of older adulthood, such as dementia and depression, are stigmatized in many
cultures.
• While some older adults will participate actively in setting goals and objectives for care, as well as determining
acceptable interventions and outcomes, others will be more comfortable relinquishing this task to family
members and health care providers.
• it is essential for nurses to assess clients’ understanding of their role in the plan of care and whether or not the
plan is consistent with cultural beliefs.
SYSTEMAT IC GERIATRIC ASSESSMENT

•HEALTH HISTORY

•REVIEW OF SYSTEM

•PHYSICAL ASSESSMENT
Comprehensive
Geriatric
Assessment
SYSTEMATIC
GERIATRIC
ASSESSMENT
Comprehensive Geriatric Assessment
Comprehensive Geriatric Assessment:
Interdisciplinary Team
❑ Family

❑ Caregiver
Comprehensive Geriatric Assessment:
Goals
Comprehensive Geriatric Assessment:
Significance
Comprehensive Geriatric Assessment:
Who should be Evaluated?
Comprehensive Geriatric Assessment:
Geriatric Giants
Comprehensive Geriatric Assessment is composed of
the following components:
1. Functional Assessment
a. Activities Daily Living (ADLs)
b. Instrumental Activities of Daily Living (IADLs)
c. Advanced Activities of Daily Living (AADLs)
2. Physical Assessment
a. Circulatory Function
b. Respiratory Function
c. Gastrointestinal Function
d. Genitourinary Function
e. Sexual Function
f. Neurological Function
g. Musculoskeletal Function
h. Sensory Function
Comprehensive Geriatric Assessment is composed of
the following components:
i. Integumentary Function
j. Endocrine and Metabolic Function
k. Hematologic and Immune Function
3. Cognitive Assessment
4. Psychological Assessment
a. Quality of Life
b. Depression
5. Social Assessment
6. Spiritual Assessment
7. Other Assessment: Obesity
 Comprehensive Geriatric Assessment:
Cautionary Note
• Comprehensive assessment is not a neutral process;
• The sources of information and tools used as well as the nurse’s skill
level have consequences for the older adult’s individualized plan of care.
• The physical and social environment can support or suppress an older
adult’s abilities.
• Comprehensive assessment consists of objective and subjective
elements, and how the assessment data are interpreted is of major
importance.
• As Kane (1993) has suggested, “interpretation is an art, and it is an art
that nurses must aspire to master both as students and as practitioners.”
 • PURPOSE: to identify an older
adult’s ability to perform self-
Functional care, self-maintenance, and
Assessment physical activities, and plan
appropriate nursing
interventions.

• APPROACHES:
1)to ask questions about ability
2)to observe ability through
evaluating task completion.
Functional Assessment:
Activities of Daily Living (ADLs)
Functional Assessment:
Activities of Daily Living (ADLs)
Katz Activities of Daily Living (ADL)
Older American Resources and Services
Assessment (OARS)
• Bathing
• Dressing KATZ ADL Try This
• Toileting Assessment Series
available on Hartford
• Transferring
Institute website at
• Continence www.hartfordign.org
• Feeding
23
Functional Assessment:
Instrumental Activities of Daily Living (IADLs)
Lawton Instrumental Activities
of Daily Living (IADL)
• Ability to Telephone Mode of Transportation

• Shopping Responsibility for Own

Medication
• Food Preparation
Ability to Handle
• Housekeeping Finances
• Laundry

25
Lawton-Brody instrumental activities of
daily living (IADL) scale
Functional Assessment:
Instrumental Activities of Daily Living (IADLs)
IADLs
• At 3yrs, IADL impairment is a predictor of incident dementia

•1 impairment, OR=1
•2 impairments, OR=2.34
•3 impairments, OR=4.54
•4 impairments, lacked statistical power
Functional Assessment:
Advanced Activities of Daily Living (AADLs)
• Advanced activities of daily living include societal, family, and
community roles, as well as participation in occupational and
recreational activities.
• AADL assessment tools tend to be used less often by nurses
and more often by occupational therapists and recreation
workers to address specific areas of social tasks.
• TOOL: Canadian Occupational Performance Measure (COPM)
• The COPM asks older adults to identify daily
activities that are difficult for them to do but,
at the same time, are self-perceived as being
important to do.
• The tool asks about self-care activities
(personal care, functional mobility, and
community management), productivity (paid/
unpaid work, household management, and
play/ school), and leisure (quiet recreation,
active recreation, and socialization).
• Consequently, interventions to enhance and
support ability are planned to address those
activities of importance to the older adult.
Mobility
The Get Up and Go Test is a practical balance and gait
assessment test for an office assessment. The Timed Up and
Go Test is another test of basic functional mobility for frail
elderly persons.
Balance can also be evaluated using the Functional Reach Test.
In this test the patient stands next to a wall with feet
stationary and one arm outstretched. They then lean forward
as far as they can without stepping. The reach distance of less
than six inches is considered abnormal. If further testing is
advisable, the Tinetti Balance and Gait Evaluation is the
standard.
Get up and Go test
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.
• Rise from an armless chair without using hands.
• Stand still momentarily.
• Walk to a wall 10 feet away.
• Turnaround without touching the wall.
• Walk back to the chair.
• Turn around.
• Sit down.
Individuals with difficulty or demonstrate unsteadiness performing this
test require further assessment.
“Get up and Go”
• ONLY VALID FOR PATIENTS NOT USING AN ASSISTIVE DEVICE
• Get up and walk 10ft, and return to chair

• Seconds Rating
• <10 Freely mobile
• <20 Mostly independent
• 20-29 Variable mobility
• >30 Assisted mobility

• Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “Get-up and Go” test. Arch phys Med Rehabil. 1986;
67(6): 387-389.
Get up and Go
• Sensitivity 88%
• Specificity 94%
• Time to complete <1min.
• Requires no special equipment

• Cassel, C. Geriatric Medicine: An Evidence-Based Approach, 4th edition, Instruments to Assess

Functional Status, p. 186.
Shoulder Function
• A simple test is to inquire about pain and observe range of
motion. Ask the patient to put their hands behind their head
and then in back of their waist. If any pain or limitation is
present, a more complete examination and potentially referral
are recommended.
Hand Function
The ability grasp and pinch are needed for dressing,
grooming, toileting and feeding.
to pick up small objects (coins, eating utensils, cup) from a
flat surface.
Another measure is of grasp strength.
The patient is asked to squeeze two of the physician or
examiner’s fingers with each hand.
Pinch strength can be assessed by having the patient firmly
hold a paper between the thumb and index finger