LET’S BEGIN!

Unit 1 – Week (1) – Comprehensive Assessment

Intended Learning Outcomes ( Week 1-ILO )

At the end of the unit, you are expected to:

1. Discuss Comprehensive Geriatric Assessment

2. Describe the different physical, psychological and spiritual changes

among elderly clients.

Introduction

We all start to age from the moment we are born. Aging is a lifespan
process that influences every aspect of our lives. Yet, many people do not
think about growing older or the issue that accompanying growing older
until they see their parent’s health decline or experience health challenges
of their own (Robnett, 2020).

This unit will focus on the definitions of interest and any other terms
related. It also deals with the basic concept of simple interest and discount.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.

Unlocking of Difficulties

To attend the following intended learning outcomes for the first

lesson of the course, you need to fully understand the following essential
knowledge that will be laid down in the succeeding pages. Please note that
you are not limited to exclusively refer to these resources. Thus, you are
expected to utilize other books, research articles and other resources that
are available in the library e.g. ebrary, search.proquest.com etc.

Key Terms

Presbyopia- a condition associated with aging of the eye that result in

progressively worsening ability to focus clearly on close object.

Cataract- a medical condition in which the lens of the eye becomes

progressively opaque, resulting in blurred vision.

Polypharmacy- is the concurrent use of multiple medications by a patient.

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Comorbidity-the simultaneous presence of two chronic diseases or
condition in a patient.

Anosmia-complete loss of smell

Lecture Notes

Unit 1- Comprehensive Assessment

 A Comprehensive geriatric assessment (CGA) is a process used by
healthcare practitioners to assess the status of people who are frail
and older in order to optimize their subsequent management. It is
also designed to evaluate an older an older person’s functional
ability, physical health, cognition and mental health and socio-
environmental circumstances.

1.PHYSICAL CHANGES IN OLDER ADULT

Change may be the only constant in our lives, sensory, perceptual and
physical changes may be observed, and these are:

A.EYES and Vision

https://opto.ca/health-library/the-aging-eye Retrieved on August 8,202

 Eyelids baggy and wrinkled, eyes deeper in sockets, conjunctiva

thinner and yellow.

 Quantity of tears decreases, Iris fades Pupils smaller, let in less light
Night and depth vision less,” Floaters” can appear, lens enlarges.

 Both cornea and lens undergo predictable changes.

 The lens become opaque thicker and more opaque resulting in blurry
vision, night vision issues and sensitivity to glare.

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B .Ears and Hearing Loss

https://www.upi.com/Health_News/2016/04/25/Hearing-aids Retrieved on August 8,2020

 Irreversible, sensor neural loss with age, men more affected than
women.
 Loss occurs in higher range of sound by 60 years, most adults have
trouble hearing above 4000Hz Normal speech 500-2000Hz.

C. Respiratory System

https://www.google.com/search?q=image+on+lungs+older+adult Retrieved on August 8,2020

 Lungs become more rigid, pulmonary function decreases,number and

size of alveoli decreases,vital capacity declines,reduction in
respiratory fluid, bony, changes in chest cavity,decreased cough
efficiency, reduced ciliary activity,vulnerable to respiratory infections.

D. Cardiovascular System

https://www.google.com/search?q=image+on+cardiovascular+older+adults Retrieved on August 8,2020

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  Heart smaller and less elastic with age, by the age of 70, cardiac
output reduced 70%, heart valves become sclerotic & tortuous, heart
muscle more irritable & arteries lose their elasticity, more
arrhythmias, arteries more rigid and veins dilate.

E. Gastrointestinal System

https://www.google.com/search?q=image+on+gastrointestinal+older+adults Retrieved on August 8,2020

 Reduced GI secretions, reduced GI motility, decreased weight of

liver,reduced regenerative capacity of liver,liver metabolizes less
efficiently.
 In old age, the rate of gastric secretion decreases and incidence of
peptic ulcer and gastritis increases. These gastric problems in adult
may be a result of Helicobacter pylori, drug ingestion or genetically
programmed changes that may occur in old age.

F. Excretory System

https://www.google.com/search?q=image+on+genitourinary+older+adult Retrieved on August 8,2020

 The kidneys of older adults have more difficult time responding to

any added metabolic stressor on the body when nephron becomes
less efficient and fewer in numbers. Like other the other organs,
older kidneys work well under normal conditions but have reduced
tolerance for disease, whether originating from the kidneys
themselves or from other organs. This is why older adults are more
likely to experience acute or chronic renal failure than younger
individual.

G. Musculoskeletal System

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 https://www.google.com/search?q=image+on+musculoskeletal+older+adult Retrieved on August 8,2020

 Musculoskeletal dysfunction is a major cause of disability in older

adults altering mobility, fine motor control, and the mechanics of
respiration. It occurs as a result of a decline in muscle mass
( sarcopenia ), which causes overall strength to deteriorate. Other
changes that take place within musculoskeletal system include
decreased reflexes, loss of cartilage and thinning of the vertebrae,
decrease calcium absorption, joint cartilage deterioration and
deterioration of extrapyramidal system.

 As people age, their joints are affected by changes in cartilage and in

connective tissue. The cartilage inside a joint becomes thinner, and
components of the cartilage (the proteoglycans—substances that
help provide the cartilage's resilience) become altered, which may
make the joint less resilient and more susceptible to damage. Thus,
in some people, the surfaces of the joint do not slide as well over
each other as they used to. This process may lead to osteoarthritis.
Additionally, joints become stiffer because the connective tissue
within ligaments and tendons becomes more rigid and brittle. This
change also limits the range of motion of joints.

H. Nervous System

https://www.google.com/search?q=image+on+nervous+system+older+adults Retrieved on August 8,2020

 The nervous system in older adult loses nerve cell mass and shows
some brain atrophy. Nerve cells and dendrites decline in number,

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 which allows transformation, shortens reaction times and weakens
reflexes. Brain weight is said to decrease with age, but this does not
seem to interfere with individual thought process.

 As one ages there is a loss of up to 10,000 nerve cells a day. While

there is a loss of all cell types in the body as part of the aging process,
nerve

 cells do not reproduce so the lost cells are not replaced. The loss of
nerve cells results in a decreases in the function of the nervous
system. The exact function lost is depended on the individual and
the exact cells lost. As there are many more nerve cells than are
necessary for the proper functioning of the nervous system, it is
unlikely that routine loss of nerve cells causes any apparent problems
until advanced old age.

I.ENDOCRINE SYSTEM

https://www.google.com/search?q=image+on+endocrine+system+in+older+adults Retrieved on August 8,2020

 As the body ages, changes occur that affect the endocrine system,
sometimes altering the production, secretion, and catabolism of
hormones. For example, the structure of the anterior pituitary gland
changes as vascularization decreases and the connective tissue
content increases with increasing age.
 This restructuring affects the gland’s hormone production. For
example, the amount of human growth hormone that is produced
declines with age, resulting in the reduced muscle mass commonly
observed in the elderly.
 The adrenal glands also undergo changes as the body ages; as fibrous
tissue increases, the production of cortisol and aldosterone
decreases.
 Interestingly, the production and secretion of epinephrine and
norepinephrine remain normal throughout the aging process.

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J.IMMUNE SYSTEM

https://www.google.com/search?q=image+on+immune+system+in+older+adult Retrieved on August 8,2020

 The age related decline of immune system functioning gives arises to

three general categories of illness that preferentially afflict older
adults:
 Infection
 Cancer
 Autoimmune disease

 The overall incidence of infectious disease rises in late adulthood.

Infection diseases, particularly prevalent among older adults are
 Influenza
 Pneumonia
 Tuberculosis
 Meningitis
 Urinary tract infection.

 Cancer increases in prevalence with age such as:

 Leukemia
 Lung
 Prostate
 Breast
 Stomach
 Pancreatic cancer
 With aging, the outer skin layer (epidermis) thins, even though the
number of cell layers remains unchanged.
 The number of pigment-containing cells (melanocytes) decreases.
The remaining melanocytes increase in size.
 Aging skin looks thinner, paler, and clear (translucent).
 Large pigmented spots, including age spots, liver spots, or lentigos,
may appear in sun-exposed areas.
 Changes in the connective tissue reduce the skin's strength and
elasticity known as elastosis and more noticeable in sun-exposed
areas (solar elastosis).

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  Elastosis produces the leathery, weather-beaten appearance
common to farmers, sailors, and others who spend a large amount of
time outdoors.
 The blood vessels of the dermis become more fragile that leads to:
 Bruising
 Bleeding under the skin (often called senile purpura) 
 Cherry angiomas
 Sebaceous glands produce less oil as you age.
 Men experience a minimal decrease, most often after the age of 80.
 Women gradually produce less oil beginning after menopause.
 This can make it harder to keep the skin moist, resulting in dryness
and itchiness.
 The subcutaneous fat layer thins so it has less insulation and padding.
 This increases your risk of skin injury and reduces your ability to
maintain body temperature because you have less natural insulation,

 you can get hypothermia in cold weather.
 The sweat glands produce less sweat that makes it harder to keep
cool.
 Your risk for overheating or developing heat stroke increases.
 Growths such as: 
 skin tags
 warts
 rough patches (keratoses)

EFFECT OF CHANGES

 As you age, you are at increased risk for skin injury.

 Your skin is:
 thinner
 more fragile
 lose protective fat layer
 You also may be less able to sense:
 touch
 pressure
 vibration
 heat
 and cold
 Rubbing or pulling on the skin can cause skin tears.
 Fragile blood vessels can break easily.
 Bruises, flat collections of blood (purpura), and raised collections of
blood (hematomas) may form after even a minor injury.
 Pressure ulcers can be caused by:
 skin changes

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  loss of the fat layer
 reduced activity
 poor nutrition
 and illnesses
 Sores are most easily seen on the outside surface of the forearms,
but they can occur anywhere on the body.
 Aging skin repairs itself more slowly than younger skin. Wound
healing may be up to 4 times slower.
 This contributes to pressure ulcers and infections. 
Factors Affects Healing:
 diabetes
 blood vessel changes
 lowered immunity

COMMON PROBLEMS
Skin disorders are so common among older people that it is often hard to
tell normal changes from those related to a disorder. More than 90% of all
older people have some type of skin disorder.

 Skin disorders can be caused by many conditions including:

Blood vessel diseases, such as 
 arteriosclerosis
 diabetes
 heart disease
 liver disease
 nutritional deficiencies
 obesity
 reactions to medicines
 stress
 Other causes of skin changes:
 allergies to plants and other substances
 climate
 clothing
 exposures to industrial and household chemicals
 indoor heating
 Sunlight can cause:
 Loss of elasticity (elastosis)
 Noncancerous skin growths (keratoacanthomas)
 Pigment changes such as liver spots
 Thickening of the skin
 Sun exposure has also been directly linked to skin cancers including:
 basal cell cancer
 squamous cell carcinoma
 melanoma

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A .Major Components

1.FUNCTIONAL CAPACITY OF AN ADULT

 Refers to the ability to perform activities necessary or desirable in
daily life.
 Functional status is directly influenced by health conditions,
particularly in the context of an elder's environment and social
support network.
 Changes in functional status (eg, not being able to bathe
independently) should prompt further diagnostic evaluation and
intervention.
 Measurement of functional status can be valuable in monitoring
response to treatment and can provide prognostic information that
assists in long-term care planning.

2. FALL RISK
 The injury rate for older adults falls in the midrange for all age group,
with 196 per 196 per 1000 persons injured among those aged 65
years old and older (Department of Commerce, 2010 ).
 Older women have a higher rate of injuries than any adult female age
group whereas the rate among men declines through the years.
 Accidents rank as the six-leading cause of death for older adults, with
falls leading cause of injury related deaths.
 Approximately one-third of community-dwelling persons age 65
years and one-half of those over 80 years of age fall each year.
 Patients who have fallen or have a gait or balance problem are at
higher risk of having a subsequent fall and losing independence.
 An assessment of fall risk should be integrated into the history and
physical examination of all geriatric patients (algorithm 1). (See "Falls
in older persons: Risk factors and patient evaluation", section on
'Falls risk assessment' and "Causes and evaluation of neurologic gait
disorders in older adults".)

3.COGNITION
 It decreases with age due to cumulative nature of lifestyle choices
(e.g., in the realm of nutrition, self- neglect, or substance use or
abuse).
 The incidence of dementia increases with age, particularly among
those over 85 years, yet many patients with cognitive impairment
remain undiagnosed. The value of making an early diagnosis includes
the possibility of uncovering treatable conditions. The evaluation of
cognitive function can include a thorough history and brief cognition
screens.

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  If these raise suspicion for cognitive impairment, additional
evaluation is indicated, which may include detailed mental status
examination, neuropsychologic testing, tests to evaluate medical
conditions that may contribute to cognitive impairment (eg, B12,
thyroid-stimulating hormone [TSH]), depression assessment, and/or
radiographic imaging (computed tomography [CT] or magnetic
resonance imaging [MRI]). 

4.MOOD
 Psychological changes can be influenced by general health status,
genetic factors, educational achievements, activity and physical and
social changes.
 Depressive illness in the elder population is a serious health concern
leading to unnecessary suffering, impaired functional status,
increased mortality, and excessive use of health care resources.
(See "Diagnosis and management of late-life unipolar depression".)

5.POLYPHARMACY
 Older persons are often prescribed multiple medications by different
health care providers, putting them at increased risk for drug-drug
interactions and adverse drug events. The clinician should review the
patient's medications at each visit.
 The best method of detecting potential problems with polypharmacy
is to have patients bring in all of his/her medications (prescription
and nonprescription) in their bottles.
 Discrepancies between what is documented in the medical record
and what the patient is actually taking must be reconciled.
 As health systems have moved towards electronic health records and
e-prescribing, the potential to detect potential medication errors and
interactions has increased substantially.
 Although this can improve safety, record-generated messages about
unimportant or rare interactions may lead to "reminder fatigue."
 The high prevalence of health condition in the older population
causes this group to use a large member and variety of medication.
Drug use by older adults has been steadily increasing every year,
most older people use at least one drug regularly.
 Researchers have found that the number of drugs used by older
persons increase with age.

The most used drugs by the older population include:

 cardiovascular agents
 antihypertensive
 analgesics
 antiarrhritic agents
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  sedatives
 tranquilizers
 laxatives
 antacid
6.SOCIAL SUPPORT

https://www.google.com/search?q=image+on+social+support+in+older+adult Retrieved on August 8,2020

 Social support is characterized by the functional and qualitative

dimension of the network of social relations and may be offered
by means of help, care or instrumental, economic social, physical
and emotional accompaniment, exercised reciprocally or
unilaterally.
 Having a positive social lifestyle can increase an elderly person's
psychological and physical w
 ell-being, lowering their amount of stress, and helping treat issues
such as anxiety or depression.
 The existence of a strong social support network in an elder's life can
frequently be the determining factor of whether the patient can
remain at home or needs placement in an institution.
 A brief screen of social support includes taking a social history and
determining who would be available to the elder to help if he or she
becomes ill.
 Early identification of problems with social support can help planning
and timely development of resource referrals.
 For patients with functional impairment, the clinician should
ascertain who the person has available to help with activities of daily
living.

7.FINANCIAL CONCERN

https://www.google.com/search?q=image+on+financial+concer+in+older+adult Retrieved on August 8,2020

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  Older adults’ financial situations are a function of their income,
wealth, costs, and debts, with housing costs a major piece of the
household budget.
 The financial situation of a functionally impaired older adult is
important to assess. Elders may qualify for state or local benefits,
depending upon their income.
 Older patients occasionally have other benefits such as long-term
care insurance or veteran's benefits that can help in paying for
caregivers or prevent the need for institutionalization.

8.GOALS OF CARE

 Older adult patients who are appropriate for CGA have limited
potential to return to fully healthy and independent lives. Hence,
choices must be made about what outcomes are most important for
them and their families.
 Goals of care often differ from advance care preferences that focus
on future states of health that would be acceptable, determination of
surrogates to make decisions, and medical treatments.
 Generally, advance directives are framed in the context of future
deterioration of health status.
 By contrast, a patient’s goals of care are often positive (eg, regaining
a previous health status, attending a future family event). Frequently,
social (eg, living at home, maintaining social activities) and functional
(eg, completing ADLs without help) goals assume priority over
health-related goals (eg, survival).
 They are also patient-centric and individualized. For example,
regaining independent ambulation after a hip fracture may be a goal
for one patient whereas another might be content with use of a
walker.
 Both short-term and longer-range goals should be considered and
progress towards meeting these goals should be monitored,
including reassessment if goals are not met within a specified time
period. One approach that has been used in CGA is Goal Attainment
Scaling .

9.ADVANCE CARE PREFERENCES

 Clinicians should begin discussions with all patients about
preferences for specific treatments while the patient still has the
cognitive capacity to make these decisions.
 These discussions should include preparation for in-the-moment
decision-making which includes :
 choosing an appropriate decision-maker
 clarifying and articulating patients’ values over time
 thinking about factors other than the patient's stated preferences in

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 surrogate decision-making.

 As an example, patients who want to extend their life as long as

possible might be asked about what should be done if the patient’s
health status changes and doctors recommend against further
treatment, or if it becomes too hard for loved ones to keep them at
home.
 Advance directives help guide therapy if a patient is unable to speak
for him or herself and are vital to caring optimally for the geriatric
population:
 Advance care planning is one key element to achieving patient
autonomy by allowing patients to participate in decisions about their
medical care.
 Advance care planning is based on the premise that on-going
discussions about end-of-life issues accompanied by written advance
directives are valuable to help loved ones, physicians, and other
providers better understand and make treatment decisions
consistent with patients' wishes, if the patient becomes
incapacitated.

ADDITIONAL COMPONENTS

1.NUTRITION/ WEIGHT

https://www.google.com/search?q=nutritional+stutus++in+older+adult Retrieved on August 8,2020

 Older persons are particularly vulnerable to malnutrition. Moreover,

attempts to provide them with adequate nutrition encounter many
practical problems.
 First, their nutritional requirements are not well defined.
 Since both lean body mass and basal metabolic rate decline with age,
 an older person’s energy requirement per kilogram of body weight is
 also reduced.

2.URINARY CONTINENCE

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  Urinary frequency, urgency, and nocturia accompany bladder
changes with age. Bladder muscles weaken and bladder capacity
decreases.

 Emptying of the bladder more difficult; retention of large volumes of

urine may result.

3.SEXUAL FUNCTION

 Many people want and need to be close to others as they grow older.
 It includes the desire to continue an active, satisfying sex life.
 With aging, that may mean adapting sexual activity to accommodate
physical, health, and other changes.

4.VISION/ HEARING

https://www.google.com/search?q=image+on+hearing+impairment+in+older Retrieved on August 8,2020

 Change in vision is due to alteration to structural components of the

visual system.
 The sharpness of your vision (visual acuity) gradually declines.
 The most common problem is difficulty focusing the eyes on close-up
objects. This condition is called presbyopia. Reading glasses, bifocal
glasses, or contact lenses can help correct presbyopia.
 Common eye disorders that cause vision changes that are NOT
normal includes:

 Cataracts- clouding of the lens of the eye

 Glaucoma-rise in fluid pressure in the eye
 Macular degeneration- disease in the macula (responsible for central
vision) that causes vision loss
 Retinopathy -- disease in the retina often caused by diabetes or high
blood pressure

 Hearing occurs after sound vibrations cross the eardrum to the inner

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 ear.
 The vibrations are changed into nerve signals in the inner ear and are
carried to the brain by the auditory nerve.
 Structures inside the ear start to change and their functions decline.
Your ability to pick up sounds decreases.
 You may also have problems maintaining your balance as you sit,
stand, and walk.

5.Dentition

https://www.google.com/search?q=dentition+in+older+adult . Retrieved on August 8,2020

 Only in the last decade has the possible effect of oral health on the
general health and mortality of elderly people attracted much
attention.
 An association between number of teeth and mortality has been
reported in several studies. As people age, many lose teeth.
 Tooth loss reduces masticatory capacity, which can influence food
selection, nutritional status, and general health.
 Evidence is also increasing that oral infections play a role in the
pathogenesis of some systemic diseases.

6.Living condition

 The World Health Organization defined quality of life as an

“individual perception of his or her living situation, understood in a
cultural context, value system and in relation to the objectives,
expectations and standards of a given society”.
 From this perspective, health-related quality of life includes areas
such as physical health, psychological state, level of independence of
the person, personal relationships, beliefs in a particular context or
the natural environment, social support, and perceived social
support.

7.Spirituality

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  Is the essence of our being that transcends and connect us to the
Divine and other living organisms. It involves relationships and
feelings (Eliopoulos, 2014).
 Spiritual Needs
 Love
 Meaning and purpose
 Hope
 Dignity
 Forgiveness
 Gratitude
B. Best Indication for CGA

1. Age
 Older people admitted for acute inpatient hospital care are at high
risk of adverse events, long stays, readmission and long term care
use.
 There is considerable evidence on assessment and co-ordination of
care for older patients with complex needs using Comprehensive
Geriatric Assessment.

2.Medical Comorbidity

 Older adults generally have multiple medical problems as well as

subclinical changes in several physiologic systems.

3.Psychological Disorders

 Mental health indicates a capacity to cope effectively with and

manage life’s stresses in an effort to achieve a state of emotional
homeostasis.

Selected Mental Health Conditions:

 Depression
 Anxiety
 Alcohol abuse
 Hypochondriasis

Specific geriatric condition:

 Dementia
 Fall

Focus Question

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Instruction: Answer the following questions in complete sentence with
rubrics provided via messenger.

1. Explain the importance of conducting comprehensive assessment

among older adult.

2. Discuss the effect of medication use among older client.

3. Describe the physiological and psychological changes among older

person.

Related Readings

For supplemental readings on Comprehensive Assessment please refer to

the sources provided.

Assessment Activities

Directions: Answer the following essay questions with rubrics provided via
messenger.

1. Discuss Comprehensive Geriatric Assessment

2. Describe the different physical, psychological and spiritual changes

among elderly clients.

References

Books

Maree, Bernoth (2016). Healthy Ageing and Aged Care.

Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )

Eliopolous. C.,( 2014 ) Gerontogical Nursing ( 8th ed. )

Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society

Electronic.

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 1.https://courses.lumenlearning.com/atd-herkimer-
biologyofaging/chapter/development-and-aging-of-the-endocrine-system/.
2. https://www.hindawi.com/journals/jar/2011/156061/
3. https://www.hindawi.com/journals/jar/2018/4086294/
4. https://www.hindawi.com/journals/jar/2018/4086294/
5.https://academic.oup.com/ageing/article/47/1/149/4682984
6.https://academic.oup.com/biomedgerontology/article

UNIT 2 – WEEK (2 )- CONDUCTING ASSESSMENT

Intended Learning Outcomes ( Week 2- ILO )

At the end of the unit, you are expected to:

1. Explain the purpose of conducting the assessment.
2. Discuss the method of conducting the assessment.

Introduction

The ability to assess patients in a holistic manner is a skill integral to nursing

regardless of the practice setting. Eliciting a complete health history, using
appropriate physical assessment skills, while respecting, spiritual and
cultural consideration Cheever,et al,2020).

This unit will focus on the definitions of interest and any other terms
related. It also deals with the basic concept of simple interest and discount.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.

Unlocking of Difficulties

To attend the following intended learning outcomes for the first

lesson of the course, you need to fully understand the following essential
knowledge that will be laid down in the succeeding pages. Please note that
you are not limited to exclusively refer to these resources. Thus, you are
expected to utilize other books, research articles and other resources that
are available in the library e.g. ebrary, search.proquest.com etc.

Key Terms

Syndrome- a group of symptoms which consistently occur together, or a

condition characterized by a set of associated symptoms.

Delirium- is an abrupt change in the brain that causes mental confusion and

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emotional disruption.

Dietician- is a medically trained professional that alters an individual's diet

based on medical conditions ...

Multifactorial-caused or marked by a polygenic mode of inheritance

dependent on a number of genes at different loci.

Podiatrists- a person who treats the feet and their ailments.

Lecture Notes

UNIT 2-CONDUCTING THE ASSESSMENT

https://www.google.com/search?q=image+on+conducting+assessment+on+elder Retrieved on August 10,2020

 Geriatric conditions such as functional impairment and dementia are

common and frequently unrecognized or inadequately addressed in
older adults.
 Identifying geriatric conditions by performing a geriatric assessment
can help clinicians manage these conditions and prevent or delay
their complications.
 Geriatric syndrome is a term that is often used to refer to common
health conditions in older adults that do not fit into distinct organ-
based disease categories and often have multifactorial causes.
 The lists includes conditions such as:
 cognitive impairment
 delirium
 incontinence
 malnutrition
 falls
 gait disorders
 pressure ulcers
 sleep disorders

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  sensory deficits
 fatigue
 dizziness
 These conditions are common in older adults, and they may have a
major impact on quality of life and disability.
 Geriatric syndromes can best be identified by a geriatric assessment.
 Although the geriatric assessment is a diagnostic process, the term is
often used to include both evaluation and management.
 Geriatric assessment is sometimes used to refer to evaluation by the
individual clinician (usually a primary care clinician or a geriatrician)
and at other times is used to refer to a more intensive
multidisciplinary program, also known as a comprehensive geriatric
assessment (CGA).
 The range of health care professionals working in the assessment
team varies based on the services provided by individual
comprehensive geriatric assessment (CGA) programs.

 In many settings, the CGA process relies on a core team consisting

the following:
 clinician
 nurse
 social worker
 physical and
 occupational therapists
 dieticians
 pharmacists
 psychiatrists
 psychologists
 dentists
 audiologists
 podiatrists
 opticians
 These professionals are usually on-staff in the hospital setting and
are also available in the community, access to and reimbursement
for these services have limited the availability of CGA programs.
 Traditionally, the various components of the evaluation are
completed by different members of the team, with considerable
variability in the assessments.
 The medical assessment of older persons may be conducted by a
physician (usually a geriatrician), nurse practitioner, or physician
assistant.
 The core team (geriatrician, nurse, social worker) may conduct only
brief initial assessments or screens for some dimensions.

Focus Questions

21
Instructions: Answer the following questions in complete sentence with
rubrics provided via messenger.

1. What is the impact of health care professionals to geriatric clients in

conducting accurate assessment?

2. How does a geriatric condition affect their lives?

Related Readings

For supplemental readings on the conducting assessment, please see these

link
https://www.google.com/search?
q=journal+of+comprehensive+assessment+on+elderly
https://www.youtube.com/watch?v=9ZoJZwE4If8

Learning/ Assessment Activities

Direction: Send your answer thru messenger to be submitted next week.

Rubrics will be given via messenger for the basis of your grade.

1. Explain the purpose of conducting the assessment.

2. Discuss the method of conducting the assessment.

Reference:

Maree, Bernoth (2016). Healthy Ageing and Aged Care.

Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )

Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society

Unit 3- Week ( 3 )- INFORMATION TO BE COLLECTED

Intended Learning Outcome (Week 3-ILO )

At the end of the unit, you are expected to:

1. Discuss the significance of data collection.

22
 2. Contrast Urinary and Fecal Incontinence.

Introduction

Collecting healthcare data generated across a variety of sources encourages

efficient communication between doctors and patients, and increases the
overall quality of patient care providing deeper insights into specific
conditions.

This unit will focus on the definitions of interest and any other terms
related. It also deals with the basic concept of simple interest and discount.

Please proceed immediately to the “Unlocking of Difficulties” part since

the first lesson is also definition of essential terms.

Unlocking of Difficulties

To attend the following intended learning outcomes for the first

lesson of the course, you need to fully understand the following essential
knowledge that will be laid down in the succeeding pages.
Key Terms

Therapeutic Interventions- is an effort made by individuals or groups to

improve the well-being of someone else who either is in need of help but
refusing it or is otherwise unable to initiate or accept help.

Dementia- is a general term for loss of memory, language, problem-solving

and other thinking abilities that are severe enough to interfere with daily
life.

Comorbidities- the simultaneous presence of two chronic diseases or

conditions in a patient.

Epidemiological studies measure the risk of illness or death in an exposed

population compared to that risk in an identical, unexposed population.

Degenerative Disease- is the result of a continuous process based

on degenerative cell changes, affecting tissues or organs, which will
increasingly deteriorate over time.

Lecture Notes

23
UNIT 3- INFORMATION TO BE COLLECTED

1.Ability to perform functional task and need for assistance

 The assessment of functional abilities in older adults refers to a

comprehensive assessment to determine the level of
independence that older adults have when performing activities of
daily living.
 This assessment enables the planning of therapeutic interventions,
social care and clinical support, and also supports clinical reasoning in
detecting early signs of dementia.

2.Fall History
 Falls are defined as an unintentional lowering to rest from a higher to
a lower position, not due to loss of consciousness or violent impact
(Kellogg International Work Group on the Prevention of Falls by the
Elderly, 1987).
 Falls often go unrecognized by health care professionals because
they are not routinely evaluated while taking a patient’s history or
during a physical exam (unless there is frank injury).
 Many patients do not admit to falling for fear of losing their
independence.
 Many factors that contribute to fall risk in older adults. The World
Health Organization Europe (2004) has characterized risks into two
broad categories, intrinsic and extrinsic risk factors for falls.
 Intrinsic risk factors include a history of falls, age, gender, medical
conditions, impaired mobility and gait, sedentary behavior,
psychological status, nutritional deficiencies, impaired cognition,
visual impairments and foot problems.
 Many older adults have multiple comorbidities including
neurological, cardiovascular, metabolic, urinary, musculoskeletal, and
psychological disorders that may increase their risk of falls.

3.Urinary and Fecal Incontinence

 Urinary incontinence the ability of the kidneys to regulate the
concentration of the bodily substances according to need diminishes
with age.
 Pain in older adults is common and has a tremendous impact on
quality of life in this age group.

 There is great variability in the reported prevalence, likely due to

differences in the reporting period for pain, the intensity of pain
reported, and composition of the older population studies.
 Crook et al 5 reported age-specific rates 29% for those aged between
71 and 80 years when asked “how often are you troubled by pain

24
 during the past 2 weeks…” Brattburg et al6 reported a 12-month
prevalence of mild to severe pain in 75% in those over 75 years of
age.
 Epidemiologic studies commonly show that pain affecting joints, feet,
and legs is increased with age; that pain in the head, abdomen, and
chest is reduced; but back pain frequency varies widely.7, 8, and 9.
 The high prevalence of degenerative joint disease overwhelms any
contribution from other causes in all surveys.

Focused Questions

Instructions: Explain each question, before you start answering, read the
related readings for your reference. Please organize your essay with rubrics
provided via messenger.

1. How does data collection important?

Related Readings

https://link.springer.com/referenceworkentry
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes
https://www.sciencedirect.com/topics/medicine-and-dentistry/pain-in-
older-adult
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Assessment Activities

Direction: Send your answer thru messenger to be submitted next week.

Rubrics will be given via messenger for the basis of your grade

1. Discuss the importance of data collection.

2. Contrast urinary and faecal incontinence.

References

Books
Maree, Bernoth (2016). Healthy Ageing and Aged Care.

Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )

Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society

Electronic

25
https://www.uth.tmc.edu/hgec/GemsAndPearls/geriatricSyndromes_Fall

Unit 4- Week( 4) : ELDERLY CLIENTELE DESIRE

Intended Learning Outcome ( ILO-week 4 )

At the end of the unit, you are expected to:

1. Discuss the elderly clientele desires.

2. Elaborate the elderly clientele desires.

Introduction

Older persons receiving care and services at home may have difficulty
articulating their preferences, especially those regarding abstract matters
phrased as safety versus freedom. When that query was put to home care
clients, about one-third preferred to come and go as they pleased and be less
safe; about one-third preferred to be safe and protected even with restricted
freedom; and one-third were ambivalent, undecided, or wanted both safety
and autonomy.

This unit will focus on the definitions of interest and any other terms related.
It also deals with the basic concept of simple interest and discount.
Please proceed immediately to the “Unlocking of Difficulties” part since
the first lesson is also definition of essential terms.

Unlocking of Difficulties

To attend the following intended learning outcomes for the first lesson
of the course, you need to fully understand the following essential knowledge
that will be laid down in the succeeding pages. Please note that you are not
limited to exclusively refer to these resources. Thus, you are expected to
utilize other books, research articles and other resources that are available in
the library e.g. ebrary, search.proquest.com etc.

Key Terms

Distress- is a general term used to describe unpleasant feelings or emotions

that impact your level of functioning.

Treatment- medical care given to a patient for an illness or injury.

26
Self- determination- the process by which a person controls their own life

Lecture Notes

Unit 4- Unit 4- Elderly Clientele Desire

 Be recognized as a person and not regarded as a room number, a

disease,
 Be comforted ,to have distress recognized, perceived that health
workers are making efforts to make him physically and emotionally
comfortable, the aged person can tolerate pain if he or she is not being
neglected.
 Learn what is causing health problems or distress in terminology that
he or she can understand.
 Know what treatment and care is planned, length of treatment and
what can be expected as an end result.
 Have some self- determination what about activities he or she will take
part in so long as he or she does not injure self or others.

Focused Questions

Instructions: Explain the following questions in complete sentence. Rubrics

will be provided via messenger individually.

1. What are the common health problems in elderly clients?

Related Readings

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.6.114

Assessment Activities

Direction: Send your answer thru messenger to be submitted next week.

Rubrics will be given via messenger for the basis of your grade.

1. Discuss the elderly clientele desires.

2. Elaborate the elderly clientele desires

27
References

Maree, Bernoth (2016). Healthy Ageing and Aged Care.

Robnette, H.R., Brossoie. N., & Walter,C. ( 2020) Gerontology for the Health
Care Professional ( 4th ed )

Jennifer Kim and Sally Miller (2017). Geriatric Syndrome. Journal American
Geriatric Society.

28