CARE OF THE OLDER ADULT LECTURE

NCM114
PRELIMS
Floridae Anne C. Ami

TOPIC OUTLINE ANNOUNCEMENTS

Lesson 1: Perspective on aging Sept. 6, 2022 (tuesday) Group activity posted sa GCR
(Deadline: Sept. 10- Saturday)
5-10 mins presentation only

Lesson 2: Theories of Aging Sept 12, 2022 (monday) Asynch ach to be posted in gcr

Lesson 3: Life Transistions Sept. 19, 2022 Quiz tomorrow (Sept 20, 2022)
● All topics

LESSON 1: PERSPECTIVE ON AGING

Gerontology
● The combined biologic, psychologic, and sociologic study of older adults within their environment.
● The scientific study of old age, the process of aging, and the particular problems of old people.
● Gerontologists work on the BioPsychoSocial aspects of gerontology.
○ Biology- physical health genetic vulnerabilities; drug effects
○ Social- peers; family circumstances; family relationships
○ Psychological- coping skills; social skills; family relationships; self-esteem;mental health

Subfields of Gerontology ● Geriatrics

○ The study of old age that includes the physiology,
pathology , diagnosis, and management of the
disorders and diseases of older adults.
● Social Gerontology
○ Focuses on the social aspect of growing old.
● Geropsychology
● Geropharmacology
○ Polypharmacy
■ Use of multiple medications
○ Elderly adults are at increased risk of adverse drug
effects compared to younger adult
○ They take more medications due to biologic effects of
aging and chronic illnesses
○ As simply the use of multiple medications
○ Overutilization of this drugs and increases number of
hospitalization and worsen cognitive functioning of
older adults – may contribute to falls

● Financial Gerontology
○ Multidisciplinary field of study encompassing both
academic and professional education
○ Focuses in the interaction of the longitudinal trends
 in middle aging and older aging
● Geriatric Nursing
○ The field of nursing that specializes in the nursing
process as it relates to the assessment, nursing
diagnosis, planning, implementation, and evaluation
of older adults in all environments including acute,
intermediate, and skills care as well as within the
community
● Gerontological Rehabilitation
○ Achieve optima; level of physical, mental and
psychosocial well-being of an older adult while
privind safe and secure environment
○ Example: Home for the aged

Aging vs Ageism AGING

● The process of becoming older, a process that is genetically
determined and environmentally modulated.
● Gradual physiological changes
AGEISM
● A bias against older people based solely on their
chronologic age, without consideration of their functional
status
● Preconceptions and biases based on chronological age.

Types of Aging ● Chronological aging

○ Reckoned by the number of years lived since birth.
● Physical aging
○ Growing old physically as a result of the passage of
time
○ Physical changes; having wrinkles, white hair; voice
changes; puberty
● Functional aging
○ This reflects our ability to carry out an independent,
self-sufficient life in which we take care of our own
personal needs like self-care

Growing older, or chronological aging is a relentless and

unstoppable process that happens to all humans. For that reason
alone, some bioethicists argue that aging is, in fact, a natural
developmental process for human beings (Meilaender, 2011)
It is senescence that cause diseases of aging. (deterioration with
age, as of a cell’s power of division and growth)

THE AGING POPULATION (Demography of aging and its implications for health and nursing)

The Older Adult: Age Identity ● Young-old: 65-75 years

● Old: 75 to 85 years
● Oldest-old: 85+

Demographics of Aging ● In 1990, the average life expectancy was 47.3 years
● In 1998, the figure had increased to 76.7 years
● In 2021, the average life expectancy was 76.1 years

● Life expectancy at birth for males in 2021 was 73.2 years.

 For female, life expectancy was 79.1 years
● In 2019, the number of people aged 60 years and older was
1 billion.. This number will increase to 1.4 billion by 2030
and 2.1 billion by 2050.
● Filipinos aged 60 years and above, doubled to 9.2 million in
2020 from 4.5 million 20 years ago
● By year 2034, around 40 percent of the Philippine population
would be senior
● Currently, life expectancy is 69 years old for males and 74
years old for females

Causes of Aging Population ● Demographic transitions

● Lower infant and child mortality rates
● Advancement in disease control and health technology
● Better living condition

Demographic transition 1. Pre Transition Age

○ High birth and high death rates
2. Transition Age
○ Early transition: death rates begin to fall as birth
rates remain high
○ Late transition: birth rates start to decline
3. Post transition age
○ Low birth and low death rates

Stage 1 and 2: characterized by young population

Stage 3 describes an old or aging population

Trends in Fertility ● The total fertility rate (TFR) is the average number of
children that a woman expects to have if she were subjected
to the same schedule of fertility as the woman of that
population at that specific point in time.
● It can also be interpreted as the average completed family
size per woman. To achieve zero population growth, TFR
should be at replacement level.

Figure 1. Lenlen and bogart

IMPLICATIONS OF THE ● Health Care Cost of Aging

DEMOGRAPHICS OF AGING ● Ethical and Legal Issues Affecting the Older Adult
○ Loss of rights, victimization and other grave
problems

○ Guardianship

TYPES OF GUARDIANSHIP
■ GUARDIANSHIP OF ESTATE: responsible
for financial and estate matters only
 ■ GUARDIANSHIP OF PERSON: Responsible
for non financial decision making
■ GUARDIANSHIP OF PERSON AND
ESTATE: A full guardianship of person and
estate

■ Limited guardianship: the court can choose

to let an incapacitated person retain any
rights it feels he/she is capable of exercising
on his/her own
■ Co-guardianship: can be of person, estate,
or both. This is when two persons share the
decision making responsibility equally.

○ Patient-self determination ACT (PSDA)

■ Federal law
■ To ensure that patient’s right in determination
of patient care decisions should be
communicated
■ Ex. advance directives

Aging Population in the Philippines

SITUATION OF OLDER PEOPLE ● The number of older people is growing

○ In the Philippines, the number of older people is
increasing rapidly, faster than growth in the total
population.
● In 2000, there were 4.6 million senior citizens (60 years or
older), representing about 6% of the total population. In two
decades, this has grown to 9.4 million older people or about
8.6% of the total population. The World Population
Prospects 2019 projects that by 2050, older people will
make up around 16.5% of the total population.

History of Geriatrics/ Gerontology ● ◦American Nursing Association (ANA)- formed a specialized

Nursing group for geriatric nurses in the 1960s recognized it over the
next three decades.
● ◦Programs were established to solidify the geriatric nursing
specialization and nurses were given substantial educational
opportunities through the development of Geriatric Research
Education and CLinical Centers (GRECCs)
● Caring for the aged is not a new concept in nursing;
○ Florence Nightingale pioneered this specialized field.
■ She was renowned as the first geriatric nurse
because of her nurse superintendent position
in an English institution, where she cared for
helpers and maids of wealthy women.

5 Steps to a More Positive Attitude ● So, how do we achieve a more positive outlook on getting
Toward Aging older?
● Aging experts and researchers agree that the following
 lifestyle factors can be beneficial in improving your attitude
about getting older and enhancing your quality of life. And
it’s never too late to incorporate these behaviors into your
daily routine.
1. Stay physically active– Physical activity and exercise is
highly beneficial to our physical and emotional health.
Moderate daily exercise is an excellent way of reducing
stress, maintaining a healthy weight, strengthening aging
bones and improving attitude. Experts on aging say that a
regular routine of walking and strength training is an ideal
way for many older Americans to maintain their fitness and
sense of well-being. Before starting an exercise program,
consult your doctor to decide on a plan that’s right for you.
2. Be socially engaged – Maintaining existing social
connections and creating new ones is also said to be vital to
our physical and emotional health as we age. According to
Dr. Paul Nussbaum, clinical neuropsychologistandauthor of
“Your Brain Healthy Lifestyle,” it is important for all older
Americans to remain integrated in the community, to build a
growing network of family and friends, and to be actively
engaged in life.”
3. Work on reducing your stress – While it is virtually
impossible to avoid additional stress and negative
experiences as we age, there are various useful ways to
minimize and manage it. Different techniques work for
different people, but many have found practices such as
meditation, yoga, tai chi, walking, prayer and deep breathing
exercises to be helpful. It is important to find a
stress-reduction regimen that works for you because stress
can be damaging to both mind and body.
4. Keep your brain active – Maintaining a healthy, active
brain is another key component of emotional health and
well-being as we age, and has also been linked to
preventing or delaying dementia. Activities such as
crossword puzzles, board games, reading, learning a
second language, painting, listening to classical music and
developing new skills are also considered valuable to brain
health. Today, many older Americans are also taking classes
at a local college and taking courses online to stimulate their
minds.
5. Engage in purposeful activities – Having a purpose in life
and a reason to get up every morning is considered vital to
your outlook on life, say aging experts. Think about the
things that give your life meaning and purpose and make
them a personal priority. Many older Americans find
satisfaction and personal fulfillment by engaging in a favorite
hobby or giving of themselves to others through
volunteering. Whether it’s giving time to a local hospital,
animal shelter or senior care community, researchers say
that feeling useful can enhance self-worth and mental
well-being.

Geriatric Healthcare Team

GERIATRICIANS ● ◦are fully trained physicians, M.D.s or D.O.s, who specialize

 in treating the health problems of elderly patients.
● ◦To become a geriatrician, a doctor must first complete a
three-year residency and become board-certified in either
internal medicine or family medicine.

GERONTOLOGISTS ● Gerontology is the scientific study of aging, as well as its

effect on individuals and cultures. It's a multi-disciplinary
field, including aspects of medicine, biology, psychology and
sociology and other sciences.

Are Gerontologists doctors?

● Gerontologists aren't medical doctors. They're professionals

who specialize in issues of aging or professionals in various
fields from dentistry and psychology to nursing and social
work who study and may receive certification in gerontology.

SIMILARITIES of Gerontologists ● might work side-by-side in research or elder-care facilities,

and geriatricians each bringing specialized knowledge and skills to the planof
care.
● between the two professions is that geriatricians are
fully-trained physicians, and provide direct treatment for
age-related disorders.
● might work side-by-side in research or elder-care facilities,
each bringing specialized knowledge and skills to the plan of
care.

primary difference of GERIATRICIAN

Gerontologists and geriatricians ● Geriatricians, registered nurses, social workers,
psychologists and other caregivers can earn credentials in
gerontology through coursework and continuing education,
broadening and deepening their skills in caring for the
elderly.

GERONTOLOGIST
● play a more supportive and educational role, though applied
● gerontologists might build long-term relationships with their
clients that include coordinating diet, exercise and cognitive
therapies.

A gerontology nurse ● is a nursing specialist who works directly with older adults to
provide them with specialized care and a high quality of life.

Role of the Geriatric Nurse?

● A geriatric nurse is a specialist who will help elderly patients
recover from illness or injury by providing practical care and
developing patient care plans.
●

Roles of gerontological nurse ● PROVIDER OF CARE

○ The gerontological nurse gives direct care, hands –
on –care to older adults in a variety of setting
 ○ The nurse as a provider should be educated about
the disease process and syndromes commonly seen
in older population which includes:
■ 1. knowledge of risk factors
■ 2. Signs and symptoms
■ leaders3. Usual medical treatment
■ 4. Rehabilitation
■ 5. End – of - life care
● TEACHER
○ An essential part of all nursing care is teaching
○ Gerontological focus their teaching on modifiable risk
factors and health promotion as many diseases and
debilitating conditions of aging can be prevented
through lifestyle Modifications such as healthy diet,
smoking cessation, appropriate maintenance,
increased physical activity, stress management
● MANAGER
○ Acts as Managers during everyday practice as they
balance the concerns of the patient, family, nursing
and the rest of the interdisciplinary team.
○ Nurse Managers must be skilled in leadership, Time
management , building relationship, communication
and managing change
○ They may supervise other Nursing personnel (lpn)
● ADVOCATE
○ GN Acts on behalf of older adult to promote their
best interest and strengthen their autonomy and
decision making
○ Advocacy may take many forms including active
involvement at the political level or helping to explain
medical or nursing procedures to family members
○ May also advocate through other activities such as
helping family members to choose the best nursing
care for their loved one or listening to family
members vent their frustrations about health
problems encountered.
○ Remember that GN does not mean making decisions
for older adults but empowering them to remain
independent and retain dignity, even in difficult
Situations
● RESEARCH CONSUMER
○ Appropriate level of involvement for Nurses at the
baccalaureate level.
○ GN must remain abreast of current research
literature, reading and putting them into practice
results of reliable and valid studies
○ Also using evidenced – based practice which can be
use to improve the quality of patients in all settings.
● SCOPE OF PRACTICE:
○ Defined by state regulation and also influenced by
the unique needs of the population being served in a
given setting
○ GN is practice in accordance with the standards
developed by the profession of nursing in 2001- the

LESSON 2: THEORIES OF AGING
Genetic Theory
Immunologic Theory
Wear and Tear Theory
Rate of Living Theory
Waste Theory
ANA Division of Gerontological Nursing Practice
BIOLOGICAL THEORY
● There is a positive relationship between parental age and
filial life span.
● These studies support the theory that senescence– the
process of becoming old is under genetic control and occurs
at the cellular level
● Aging results when a growth substance fails to be produced,
leading to the cessation of cell growth and reproduction.
● Autoimmune theory
○ With age, the system’s ability to produce necessary
antibodies that fight disease declines, as does its
ability to distinguish between antibodies and proteins
● Immunologic theory
○ A programmed decline in the immune system leads
to an increased vulnerability to disease, aging and
death. (ex. Decreased T cells in adults leads to
increased autoimmune diseases in adults)
An idea proposed by German biologist, Dr. August Wiesmann, in
1822. The theory suggests that aging results from a gradual
deterioration of the cells and tissues of the body via wear and tear,
oxidative stress, exposure to radiation, toxins, and other
● Suggests that each organism, and perhaps each cell, has a
specific amount of metabolic available to it and that the rate
at which this energy is used determines the organism’s
length of life.
● Modern Version
○ The theory recognizes that the number of heartbeats
does not predict lifespan. Instead, researchers
examine the speed at which an organism processes
oxygen
● Chemical wastes collect in the body and produce
deterioration by interfering with cellular functioning.
● Lipofuscin
○ Formed by a complex reaction- binds fat in the cells
to proteins - wastes accumulates in the cells as small
granules and increases in size as a person ages
○ Lipofucsin builds up over time, it has been described
as “the ashes of our dwindling metabolic fires”
Collagen Theory ● Collagen stiffens with age, producing loss of elasticity in
organs, skin, tendons, blood vessels, etc. The resultant
stiffness adversely affects function.
● Collagen
○ is the principal constituent of white fibrous
connective tissue
○ occurs in tendons and also found in skin, bone,
cartilage and ligaments.
○ Relatively inelastic
○ Has high tensile strength

Endocrine Theory ● Events occurring in the hypothalamus and pituitary are

responsible for the changes in the hormone production and
response that result in the organism’s decline
● Changes in hormones control aging.

PSYCHOSOCIAL THEORIES

Disengagement theory ● Developed by Elaine Cumming and William Henry in the late
1950’s, the basis of this theory arises from the fact that
human beings are mortal and must eventually leave their
place and role in society. Therefore, it is their responsibility
to look for suitable replacements.

Activity Theory ● Developed by Ribert Havighurst in the 1960’s.

● Assumes that the norm exists for all mature individuals. The
degree to which the individual “acts like” or “looks like” a
middle-aged person is the determinant of the aging process.
● Supports the maintenance of regular activities, roles and
social pursuits
● Persons who achieve optima age are those who stay active
● As roles change, the individual finds substitute activities for
these roles

Continuity theory ● Proposed by Havighurst and co-workers in reaction to the

disengagement theory.
● “Basic personality, attitudes, and behaviors remain constant
throughout the lifespan”
● Accounts for the continuous flow of phases in the life cycle
and does not limit itself to change
● It assumes that persons will remain the same unless there
are factors that stimulate change or necessitate adaptation

SOCIOLOGICAL THEORIES
These are the changing roles, relationships, status, and generational cohort impact the ability of older adults
to adapt.

NURSING THEORIES

Functional Consequences Theory ● Environmental and biopsychosocial consequences impact

functioning.
● Nursing’s role is the risk reduction to minimized
age-associated disability in order to enhanced safety and
quality of living
Theory of thriving ● Failure to thrive results from a discord between the
individual in his or her environment or relationship.
● Nurses identify and modify factors that contribute to
disharmony among these elements

LESSON 3: LIFE TRANSITIONS

LIFE TRANSITIONS

Aging Process

Aging process starts at conception*

Meaning of Life

● 1st trimester: both mother and child has feelings of anxiety

and fear
● 2nd trimester:
● 3rd trimester:

Philosophy of Growing Old “If you are a product of pre-marriage–there is a study that
something has gone wrong. These people are actually difficult
people to deal with. Somethings wrong with embryo formation.”

Importance of Decades of Life

1st birthday: Baby’s birthday ● Family orientation

● Guest are exclusive for relatives
○ Center of life is family
● Venue should be at home
● Age of dependency
● VENUE: at home

2nd birthday: 10 years ● Garden orientation

● Ecology - nature
● VENUE: outdoors
● Time where the child has connectedness

3rd birthday: 20 years ● Guest - same gender

 ● Heterosexual orientation
● Debut
● Courting moments
● Love and Passion
● Independence

4th birthday: 30 years ● Very important stage

● Physiologic education(promotes and disseminates
educational scholarship in order to enhance teaching and
learning)
● Considered to be very important
● By then you will be Degree Bachelors
● Orientation is employment
● You are already earning at this point
● Guests: officemates, mentors or boss

5th birthday: 40 years ● This is the height of maturity development

● Maturation of the cartilages
● Social maturity
● Life begins at 40
● A person should already be certain and secured
● A good relationship with in-laws if married.
● Should be reliable, sincere, honest
● With a house and a job
● Highly related to in-laws, friends and relatives
● Begin to think of growing old
● Knows what they will enjoy in life
● Study to the best of their ability
● Eat what they want
● Fullness of maturity
● Stories of goodness to others, auxiliaries (*providing
supplementary or additional help, and support)

6th birthday: 50 years ● Biological decline happens here

● Masteral and Doctoral Degree
● All academics are done
● Enter midlife
● Reality –that one day I will get sick and save for the future
● Begin to second rule ( crochet, cross stitches etc.)
● Life is at stake
● happy when earning more
● Very hard to in - laws
● Moment of younger girls, widows and young girls
● Grooming (perfumes)
● Cataracts and arthritis

7th birthday: 60 years ● Celebrating birthday, you invite people

● Lechon
○ Wow lechon
● 65-Teacher ( goodbye teaching)
● Enjoy pension
● Enjoy life to keep you young
● Very generous to help others
● Develop all kinds of work.
● by this time no more enemies
 ● Celebrate with a bump

8th birthday: 70 years ● Frequent doctor visits

● Assistive devices
● Circle of friends start to shrink bc of death
● Time to think and be creative
● Travel age
● Begin to discover the world

9th birthday: 80 years ● Health problems become severe

80 (3 legacies)
1st zero: biological legacies surviving any catastrophic
incidents/experiences
2nd zero: Legacy of what you learned financial, donation, develop
given talents and your way of teaching
3rd zero: Values of Spirituality - Good person, honest, integral
(completeness of an individual)

90 years ● pre-centinarian
● Frequent visitors
● You can learn from your grandchildren
● You must have forgiven all the people you have hurt
● All debt should be settled
●

100 years ● A lot of hugging

● Words of gratitude

Happy Retirement ● 60 – 65 years old

● Gainful retirement
● Earning
● Gainful employment
● Preparation
● observing sleep patterns
● Personal
● Am I related to people
● Look into your health.
● Second option:
● play guitar, if you have a guitar
● money to buy what you want
● instructor

Graceful Aging ● Normal Childhood

○ No regrets, accept and enjoy significant
achievements in life.
● Siblings camaraderie
● Parental presence
○ Grew up till age of 10 y/o
● Onward with decades of life
● Employment Age
○ Charitable acts
● Health
○ Eat, sleep, relate and pray
● Connections with relatives
 ● Peers across the world
○ Loyal friends
● Continuous reading
● Bonding outing
● Hobbies
● Music
○ 15-30 mins a day
● Travels
○ With friends and relatives
● Communications
● Meal together
● Keep on trend

Keeping Well in Older Years ● Doing something you like

● Communication – very important to get out of yourself
● Graceful acts - Sharing what you have
● Sharing- knowledge (leader to people) who will listen to you
● Detachment – no hoarding
● Sleep and rest
● Satisfying simple needs
● Enjoying relations – new friends and companions

★ HALLMARK OF HAPPY AGING IS RADIANCE OF

KINDNESS AND GOODNESS.
★ To be old passing line is 75 y/o
○ Reward
○ Race
○ Repository of Wisdom
○ Pot of Goodness and Kindness

LESSON 4: COMPREHENSIVE GERIATIC ASSESSMENT

CGA (Comprehensive Geriatric ● Multidisciplinary diagnostic and treatment process that

Assessment) identifies medical, psychosocial, and functional limitations of
a frail older person in order to develop a coordinated plan to
maximize overall health with aging.

Geriatric Syndrome ● Refer to common health conditions in order adults that do

not fit into distinct organ-based disease categories and often
have multifactorial causes.
● The list includes conditions such as cognitive impairment,
delirium, incontinence, malnutrition, falls, gait disorders,
pressure ulcers, sleep disorders, sensory deficits, fatigue
and dizziness.
○ Syndrome: group of signs and symptoms that occur
at once and characterize a particular condition
●

Center of GCA ● Physical Health and Nutrition Status

○ Chief complaints/ reason for seeking medical health
○ Annual/Follow-up check-up
○ Health history, present, past and family
 ○ Medications used and diet

● Mental and Emotional Health

○ Psychological health

● Functional Health
○ Assess activities of daily living
○ Gait and balance

● Social Health
○ Living arrangement
○ Social and financial support
○ Stress and stressors

● Environmental Health
○ Living condition, safety of client’s house

Who needs geriatric assessment? ● Patients with transitional living

○ Ex. home-nursing home, retirement, loss of spouse
● Recent development of physical or cognitive impairments
○ Newly diagnosed elderlies with Alzheimer's,
dementia, parkinson’s
● Patients with fragmented specialty medical care
● Evaluating patient competency/capacity
● Dealing with medico-legal issues
○ Abused and neglected

Elderlies are heterogenous 1. Fit patients

○ Basically are treated same as the younger patients
and they get the standard treatment
○ Characteristics:
■ Able to do strenuous activities
■ Run long distance/marathon
■ Surfing, swim miles of distance
■ Play tennis

2. Frail patients
○ Patients are referred to hospice and palliative care
○ Characteristics:
■ Wheelchair bound
■ Dependent on most of ADL’s
■ Poor hand grip
■ Malnourished

3. Neither Fit or frail

● No standard treatment guidelines for older adults.
And this is most challenging part on geriatric patients

Consider what observations are a result of normal age-related

changes compared with age-prevalent illness; diseases often
present with nonspecific and/or atypical findings as well.
Goals of CGA Highest priority
● Prevention of decline in the independent performance of
ADLs
● Drives the diagnostic process and clinical decision-making
● DScreen for functional impairments that may result in
physical disability and amenable to intervention
● Improve diagnostic accuracy
● Recommend optimal living environment
● Monitor clinical change over time
● Predict outcomes

Steps to follow in CGA

1. Targeting appropriate Targeting criteria:

patients ● Too sick to benefit - poor prognosis
● Appropriate and well benefit - can still be treated with good
prognosis
● Too well to benefit - has manageable conditions that are
manageable

Criteria to identify patients

● Age
● Medical comorbidities
● Psychosocial disorders
● Specific geriatric conditions
● Previous or predicted high health care utilization
● Consideration of change in living situation

2. Assessing patients and Assessment tools:

developing
recommendations A. Pre-visit questionnaires
■ General hx
■ Functional status
- Refers to the ability to perform activities necessary or
desirable in daily life.
○ Basic activities of daily living
■ Bathing
■ Toileting
■ Grooming
■ Transferring
■ Dressing
■ Feeding
○ Instrumental or intermediate activities of daily
living (ADLs)
■ Shopping
■ Driving of using PUV
■ Home repair
■ Preparing meals
■ Doing laundry
■ Handling finances
○ Advanced activities of daily living (AADLs)
■ Ability to ful;fill the societal and family
roles
■ Participation in recreational tasks
■ Participation in occupational tasks
■ Fall history
■ Fall assessment
Gait speed- predicts functional decline and early
mortality in older adults
○ Previous history of fall, cause, treatment
○ Injury and ability to get up
○ Location and circumstances of falls
○ Medication
■ Psychosocial aspect
■ Social Assessment
Having adequate social support is a part of caring for
older adults
● Economic status
● Availability of a personal support system
● Availability of help in case of emergency
● Need for a caregiver
★ Elder Abuse Assessment
Elder mistreatment
● Contusion
● Burns
● Genital/rectal trauma
● Malnutrition

Abuse and Neglect: Helpful Questions

(Suspected)

S Do you feel safe at home? What stress do

A Do you feel afraid or have been abused by

any of your caregivers?

F Are there family or friends that you could

ask for help or support?

E Do you have a safe place to go in case of

an emergency? Is it an emergency now?

■ Nutritional Assessment
○ Loss of 10 pounds within 6 months and no other
conditions = poor nutrition
○ Malnourishment is caused by decreased appetite on
elderly and some to side effects of treatment.
■ BMI
■ Dietary Diary: Food taken (24 hour recall)
■ Characteristics of diet
■ Alcohol and Fiber intake

■ Advance directives
Patients preferences for specific treatments while the
patient still has the cognitive capacity to make these
decisions.
 ● Code status: DNR/DNI

3. Implementing *none*
recommendations

4. Physician and patient ● Treatment and management

adherence

FIVE MODELS OF CGA ● Home Geriatric Assessment

○ Programs include a visiting nurse trained in geriatric
care, as well as a physical therapist, social worker,
psychologist, and specialty referrals when
appropriate
● Acute Geriatric Care Unit
○ Structural modifications to promote mobility and
simulate living conditions at home in preparation for
a return to independence
● Post-Hospital Discharge
○ Supplemented by telephone calls and additional
visits by physical therapy, occupational therapy,
occupational therapy, social work, and/or home
nursing services when indicated.
● Outpatient Consultation
○ Adherence to program recommendations and treat
patients at higher risk of hospitalization have led to
improved outcomes.
● Inpatient Consultation

– SUMMARY –
● Data gathering
● Discussion among the team
● Development of treatment plan
● Implementation of the treatment plan
● Monitoring response of the treatment plan
● Revising the treatment plan