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BROKENSHIRE COLLEGE SOCSKSARGEN, INC.

Ced Ave. National Highway Lagao, General Santos City
Telefax No. (083)301-4202
Email : bcsigensan@gmail.com
Fides et Servitium

Ncm 114
Care of the older adult
Module 2

Sheila Lyn U. Recidoro,RN,MAN

Instructor
August 27, 2020
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Module 2 Nursing Care of the Older Adult in Wellness

:
At the end of the module, you should be able to:

1. Assess the older adult client his/her health status/competence.

2. Perform safe, appropriate, and holistic
assessment
to older adults utilizing
the nursing process.

Introduction

Nurses have many opportunities to promote wellness for older adults through actions that are integral to
nursing. A major focus of a “wellness approach” to older adult health care is addressing the body–mind–spirit
interconnectedness of each older adult as a unique and respected individual. This requires that nurses assess
each older adult in the full context of his or her personal history and current situation. Based on this holistic
assessment, nurses identify realistic wellness outcomes and plan interventions directed toward improved
health, functioning, and quality of life. This approach may seem challenging— or even impossible—for older
adults who are seriously or terminally ill or for those who have. Overwhelming chronic conditions. Even
when there are serious physical challenges, however, nurses need to recognize that they can implement
interventions directed toward improved physical comfort and psychological and spiritual growth.

Assessment of health and functioning of older adults is an essential and complex component of nursing care.
This module discusses the general approach to assessing the older adult’s health and functioning and
provides tools for functional assessment. In addition, because health and functioning significantly affect the
ability to drive a motor vehicle—which is a major safety concern with implications for society and individual
older adults.

At the end of this module , the learner is expected to :

• Identify pertinent history data included in an older adult history.
• Obtain an older adult history.
• Describe additional physical assessment components specific to an older patient assessment.
• Perform a physical assessment on an older patient.
• Document assessment findings.

CONTENT:
Nursing Care of the Older Adult in Wellness
Assessment
Subjective Data
Nursing History
Functional Health Patterns
Objective Data
Psychological Assessment
Physical Assessment
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“Ageing concerns each and every one of us – whether young or old, male or female, rich or poor – no
matter where they live.”
(World Health Organization, 2012, as cited in Dewan, Zheng & Xia, 2012)

What Is Assessment?
 A systematic process
 Identifies patients’ strengths and limitations
 Involves collecting, validating, and clustering data

Purpose of Assessment
 Collect pertinent patient health status data
 Identify abnormal findings
 Identify patients’ strengths and coping resources
 Pinpoint actual health problems
 Identify risk factors for health problems

Assessment Skills

1. Cognitive Skills
Assessment is a “thinking process”
 Critical thinking
 Inductive and deductive reasoning
 Clinical decision-making Assessment is a “thinking process”.
 Problem-solving
 Reflexive thinking
 Trial and error
 Scientific method
 Intuition
2. Psychomotor Skills

Assessment is a “doing” process.

 Skills needed to perform the four techniques of physical assessment

3. Interpersonal/Affective Skills Assessment

is a “feeling” process.
 Affective skills needed to develop caring, therapeutic nurse–patient relationships

4. Ethical Skills
Assessment is being responsible and accountable.
 Responsible & accountable for practice
 Patient advocate
 Respect patients’ rights
 Assure confidentiality

Assessment Data
A. Subjective
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Covert, not measurable symptoms
B. Objective
Overt, measurable signs

Types of Assessment
1. Comprehensive
• Initial detailed history & physical
2. Focused
• Problem-oriented, initial, or on-going

Methods of Data Collection:

The Interview
 Types of interviews: directive or non-directive
 Types of questions: open or closed
 Interviewing tips/pitfalls
Observation
 Use all of your senses
 Look at patient and environment
 What data can you collect through observation?
Physical Assessment
 Inspection
 Palpation
 Percussion
 Auscultation
Validating Data
 Compare subjective and objective data.
 Ask patient to validate assessment data.
 Use other sources to validate data, such as family members, healthcare providers, old records,
diagnostic tests.

CHALLENGES OF CARING FOR OLDER ADULTS

A major challenge of caring for older adults is the complexity of assessing their health, especially from a
comprehensive and holistic nursing perspective. Several factors contribute to the complexity of assessing
health and functioning of older adults:
 Older adults commonly have one or more chronic conditions in addition to any acute health
conditions for which they are being assessed. These conditions often interact, causing older adults’
health to fluctuate unpredictably.
 Manifestations of illness, even acute illness, tend to be obscure and less predictable in older adults
than in younger adults. For example, in older adults, one of the most common manifestations of
illness or an adverse medication effects is a change in behavior or mental status.
 For any one manifestation of illness in an older adult, there are usually several possible explanations.
For example, changes in function can be caused by a combination of several of the following
conditions: acute illness, psychosocial factors, environmental conditions, age-related changes, a new
chronic illness, an existing chronic illness, or an adverse effect of medication(s) or other treatments.
 Treatments are often directed toward the symptoms while the source of a problem is obscure and
unresolved. This approach can mask the underlying problem even further and cause additional
complications (e.g., when adverse medication effects are not recognized as such and are treated with
additional medications).
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 Cognitive impairments can make it difficult for older adults to accurately report or describe a
physiologic problem and there may be few or no reliable sources of information.
 In many cases, by the time illness in an older adult is detected and addressed, the underlying
physiologic disturbance is in an advanced stage, and additional complications have developed.
 Myths and misunderstandings can lead health care providers, family members, or older adults to
falsely attribute treatable conditions to aging.

Assessment of the Older Adults

• Assessment of older adults is a multidimensional process addressing the complex interactions among older
adults, their health, and all contextual factors (e.g., culture, environments, medical conditions, adverse
medication effects).
• Factors that contribute to the complexity of assessing older adults include multiple interacting conditions,
unique manifestations of illness, treatments that mask the underlying problem, inaccurate or inadequate
sources of information, and myths and misunderstandings about aging.
• Nurses need to be aware of age-related variations in laboratory values for older adults
• Evidence-based nursing assessment tools and web-based articles demonstrating the use of many of these
tools are widely available

Functional Assessment
• A functional assessment is a formal process of measuring a person’s ability to fulfill responsibilities and
perform self-care tasks
• Functional assessment tools focus on the person’s ability to perform ADLs (activities of daily living
which are the tasks involved with meeting one’s basic needs independently: toileting, feeding,
dressing, grooming, bathing, and ambulation and IADLs - Instrumental activities of daily living (IADLs),
include shopping, laundry, transportation, housekeeping, meal preparation, money management, medication
management, and use of telephone.
• Assessment of the home environment is important for identifying factors that affect safety, comfort,
functioning, and quality of life
• Assessing the use of adaptive equipment and assistive devices is important for identifying factors that
affect safety, comfort, and functioning.
• Some assessment tools address the effect of cognitive impairment on ability to perform activities of
daily living
• Nurses can suggest the use of innovative and inexpensive devices to improve functioning and promote
independence.

Comprehensive Geriatric Assessments

• The Minimum Data Set (MDS) for Resident Assessment and Care Screening, includes several hundred
items that document 18 areas of functioning, such as medical, mental, and social characteristics of nursing
home residents. MDS is used in nursing facilities and home care agencies to document 18 areas of
functioning.

Assessing Older Adults in Relation to Their Environments

• Everyday competence is a term that describes the effects of cultural, physical, cognitive, emotional, social,
and contextual factors on a person’s daily functioning.
• Home assessments are essential for identifying risks for safety and interventions to improve functioning
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Assessing and Addressing Driving Safety

• Nurses have an important role in identifying risk factors that compromise safe driving in older adults.
• Common risk factors include conditions that affect vision, cognition, motor responses, and reaction time.
• Nurses address risk factors by facilitating referrals for further evaluation or for programs related to driving,
safety, education, and rehabilitation.

Assessing Function in Cognitively Impaired Older Adults

• The cognitive status and psychosocial functioning can significantly affect one’s level of functioning, it is
particularly challenging to assess function in older adults who have any cognitive or psychosocial
limitations (e.g., dementia, delirium, depression).
• Some functional assessment scales have been developed specifically for people with dementia in a variety
of settings and at all levels of cognitive impairment. These tools address the interplay between cognition
and abilities to perform ADLs. For example, the Cleveland Scale for Activities of Daily Living (CSADL) divides
each ADL into smaller components to identify specific effects of the underlying cognitive deficit. Studies
have found that this instrument is reliable and valid as a measurement of functional deficits in people with
Alzheimer’s disease (Mack & Patterson, 2006).

Assessing the Use or Potential Use of Adaptive and Assistive Devices

• The actual or potential use of items such as mobility aids (e.g., canes, walkers, wheelchairs) and adaptive
equipment (e.g., grab bars) should be assessed as factors that can significantly affect safety, functioning,
and quality of life for older adults.
• Physical, occupational, and rehabilitation therapists are skilled in assessing for the use of these aids, but
nurses need to be familiar with the array of adaptive and assistive
• Devices so that they can make recommendations or facilitate referrals for further evaluation.
• Many innovative and inexpensive devices are available through catalogues or Internet sites and can be
used to improve functioning and independence in daily activities.
• Nurses also can identify problems related to the use of assistive devices and request further evaluation by
a qualified therapist. For example, nurses can assess comfort and function of wheelchairs because
improper fit leads to specific problems.

Comprehensive Geriatric Assessment

As gerontologists and health care providers began addressing the complexity of care for older adults, they
recognized the need for assessment models that were more comprehensive than those that focused
specifically on particular aspects of health or functioning. Thus, in the early 1980s, standardized tools for
comprehensive geriatric assessments were developed, but they were not widely implemented at that time.
In 1987, the Omnibus Budget Reconciliation Act (OBRA) mandated that all Medicaid- and Medicare-funded
nursing homes begin using a standardized assessment form as part of the effort to improve quality of care
through regulation and inspections.

KATZ INDEX OF ACTIVITIES OF DAILY LIVING

 Katz’s ADL’s----developed in the 1960’s

 One measure of independence is the capacity to perform functional tasks necessary for daily living.
 Measuring six functions, each noted either as independent or dependent
 Initially used by a nurse based on observations over a week
 Since then, many modifications Mnemonic---- “DEATH” --- a way to help you remember the activities
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 Evaluated--- D= dressing, E=eating, A=ambulating, T= toileting, H=hygiene

INSTRUMENTAL ACTIVITIES OF DAILY LIVING

Includes the following activities:

• Telephone
• Traveling
• Shopping
• Preparing meals
• Housework
• Medication
• Money
Instrumental (community interactions) --- mnemonic “SHAFT”

S=shopping, 2.H=housework, 3. A=Accounting, 4. F=food preparation and

5. T=transportation
• Other domains to be assessed:

– Current health status: nutritional risk, health behaviors, tobacco, and ETOH use and exercise
– Social assessments: especially elder abuse if applicable
– Health promotion and disease prevention
– Values history: advanced directives, end of life care

ASSESSING OLDER ADULTS IN RELATION TO THEIR ENVIRONMENTS

In addition to assessing the older adult’s health and functioning, nurses need to be aware of
environmental factors that influence the person’s safety, functioning, and quality of life. Researchers and
practitioners increasingly are addressing the interrelationship between people and their environments, and
this is particularly pertinent to care of older adults. In the late 1990s, the term everyday competence was
used to describe the effects of cultural, physical, cognitive, emotional, social, and contextual factors on a
person’s daily functioning. This is particularly important to consider when assessing older adults because
these factors can appreciably hinder or improve functional abilities.

Home assessments provide an excellent base for assessing the relationship between older adults and their
environments. These assessments are essential not only for identifying fall risks but also for identifying
environmental conditions that positively or negatively affect safety, functioning, and quality of life. For
example, proper lighting is essential for performing enjoyable activities such as reading, playing cards, and
engaging in hobbies. Similarly, the ability to regulate the temperature is important not only as a safety
consideration for preventing hypothermia and hyperthermia but also for comfort. During home visits, it is
especially important for nurses to respect autonomy and privacy and be nonjudgmental, and at the same
time be able to identify all factors that affect the person’s functioning and quality of life.

For additional study aid read :

1. Evidence-Based Practice Kresevic, D. M. (2008). Assessment of function. In E. Capezuti, D. Zwicker, M.
Mezey, & T. Fulmer (Eds.), Evidence-based geriatric nursing protocols for best practice (3rd ed., pp.
23–40). New York: Springer Publishing Co.
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ACTIVITY:
Look for one older adult either male or female ( 60 years old and above ) within your family OR
COMMUNITY or someone you know personally)and accomplish the following activity.

• Get consent before doing this activity

• Perform a physical assessment on an older adult using the attached assessment form.
(page 8 -10 )
• Document assessment findings.
• Take a photo of you and the patient while assessment is made.
• REMINDER : Please wear appropriate clothing or your uniform if possible while doing the
assessment .
Output must be submitted not later than September 3,2020 via email
@nursesheilalyn@gmail.com

Subject of the email : Assessment of the Older Adult

EVALUATION :

After doing the assessment of the older adult, reflect on this question :
What can the physical assessment tell you about older adults?
Narrative answer should not be less than 100 words or more than 150 words.
Rubric:
Content / Idea ( Relevance ) - 7 pts
Organization of sentence (Connection of Ideas ) - 3 pts
Grammar, spelling - 3 pts
Promptness of submission - 2 pts
Output must be submitted not later than September 3, 2020 via email
@nursesheilalyn@gmail.com
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- End of Module 2 –

BROKENSHIRE COLLEGE SOCSKSARGEN,

INC.
Ced Ave. National Highway Lagao, General Santos City

Assessment Form

I. Biographical Data
Patient’s Name:
Age Education
Gender
Birth date Previous Occupation
Race/ethnicity
Advanced directives
Religion
Marital status
Current Health Status / Reasons of Seeking Health Care:
Past Health History
Hospitalizations
Serious injuries
Allergies
Transfusions
Surgeries
Immunizations
Medications
Recent travel
Childhood illnesses

Family History
Patient
Children
Siblings
Grandparents
Spouse
Parents
Aunts and uncles

Developmental Considerations
Past developmental stages
Current developmental stages
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Psychosocial History
Typical day
Activity & exercise
Sleep/rest patterns
Personal habits
Health practices & beliefs
Occupational health patterns
Socioeconomic status
Environmental health patterns
Role, relationships, self-concept
Cultural influences
Religious/spiritual influences
Nutritional patterns
Recreation, pets, hobbies

Physical Assessment General Survey

Level of consciousness
Obvious abnormalities or signs of distress
Affect
Dress
Speech
Posture

Vital Signs and Anthropometric Measurements

Temperature
Respirations
Height
Pulse
Blood pressure
Weight
Body Mass Index
 Comprehensive Nutritional History
24-hour recall:
Food intake records:

Mental Status Assessment

Appearance and behavior
Speech
Attitude
Mood
Perceptual disturbances
Thought process
Thought content
Affect
Memory
Insight judgment

Spiritual Assessment
Non-verbal
Verbal
Relationships
Environment

Patient’s Consent to perform assessment and document assessment for educational purpose.

Signature of Patient ________________________________

Date: _______________________________

Name of Student: ________________________________________ Date

of Submission: ______________________________________