Assessment of the Health Status of the Older Persons

Assessment is usually composed of history-taking and physical assessment. History-taking

entails an interview with the older person on certain aspects of health such as: activities of
daily living, nutrition, and specific health concerns. It is therefore important that all matters
affecting the interview are considered, such as orientation to time, person and place,
memory state, and understanding of questions. Physical assessment is the process of
examining the body for signs and symptoms of disease and other health problems. This is
done through inspection, palpation, percussion and auscultation.

Factors that Affect Validity of Assessment:

1. Aging effects and presence of diseases. It is possible due to aging effects, history-taking is
not conducted properly and some errors are committed. For example, it is possible that some
visual or hearing impairment affected by communication. It is also possible that the older
person was not properly oriented on the purpose of the interview.
-the older person may refuse to answer some questions because of depression, confusion, or
dementia.
Depression is a mood disorder, diagnosed if a person feels sad and exhibits five or more of the
following symptoms: decreased appetite, weight loss, decreased energy, decreased
concentration ability, feelings of guilt, psycho motor retardation or agitation, sleep
disturbance and thoughts of suicide.
Confusion is a brain impairment in which memory, thinking and perception are
simultaneously impaired. It has acute onset and reversible causes. Symptoms
include reduced ability to maintain or shift attention, disorganized thinking, and
two or more of the following: reduced level of consciousness, perceptual
disturbances, sleep-wake cycle disturbance, increased/decreased psychomotor
activity, disorientation to time/person/place, and memory impairment.
Dementia is a syndrome typified by chronic deterioration of memory and loss of
other cognitive functions. It is caused by structural loss or death of nerve cells in the brain; generally
progressive; includes the following symptoms: impaired abstract thinking, impaired judgement,
personality change, aphasia(disorder of language), apraxia(inability to carry out motor function), or
construction difficulty (difficulty assembling blocks or sticks)

Cognitive impairments: confusion and dementia

 Older persons with dementia communicate poorly due to impaired speech and memory.
They are often disoriented to time, person, and place. This causes a lot of concern when
conducting an interview and physical assessment. They might not answer the questions
correctly and might not cooperate. They might give information that are opposite to
what they are thinking or feeling.
Sensory deficits: Visual and hearing
 Sensory deficits are obvious reasons for difficulty in communicating with older persons.
They can be barriers to effective communication. Visual problems make it difficult for
older persons to answer questionnaires or demonstrate some activities that need to be
evaluated by the person doing the assessment. For example, certain activities of daily
living, such as cooking, walking, etc, are greatly affected by visual problems. In the
same
manner, hearing impairment can limit participation in the assessment process and
performance of daily activities. It may also be more difficult to establish rapport when
the older person can barely see or is hard of hearing.
  Certain adjustments in the conduct of assessment can be done based on existing
sensory deficits. For example, assistance in answering questions can be given to those
with poor eyesight .
Affective disorders
 It is difficult to get cooperation of a depressed person. Communication may also be
difficult. It is therefore important that the older person be pulled out of depression
before conducting assessment. If this is not possible in the short term, focusing him/her
to the purpose of the assessment should be a priority.
2. Presentation of illness. Older persons do not report signs and symptoms of diseases. This
is because they either attribute to the signs and symptoms to the normal aging process or
they are afraid to be subjected to clinical tests. Assessment must also take into consideration
the effect of one body system on another.

Underreporting of diseases
 Older persons tend to under report what they are feeling that might be symptoms of a
disease.They usually think that symptoms like forgetfulness a arthritic pain are part of
the aging process. They may also fear that reporting symptoms, they would be asked to
undergo a series of invasive laboratory tests.
 They might also fear becoming a "burden" to their family once diagnosed. These are the
reasons why many chronic illnesses are
left undiagnosed and untreated.
 During assessment, it is important that all possible reasons for under reporting are
known. Specific questions must be asked to determine presence of certain health
problems or illnesses. Information from laboratory tests must be used to determine
whether a certain disease condition is present. The older person’s fear or other
emotional concerns must also be addressed.

Atypical presentation of diseases

 The presentation of diseases among older persons does not follow the usual
development of symptoms. Due to physiologic changes, an older person may be
suffering from heart disease but does not have chest pain or other usual symptoms.
While majority have signs and symptoms that are easy to diagnose, there are others
who might just appear confused or complain of indigestion.
 Certain signs and symptoms of diseases that are reported by older persons must be
checked with corresponding laboratory test, which will provide objective evaluation. An
inquiry into the ability to perform daily activities might also provide clues if there are
changes in the health of the older person.

Multiple Interacting diseases

 The cumulative effects of bad health habits in the past make older persons candidates
for specific chronic illnesses. Decreased organ reserves also make them susceptible to
acute illness. These conditions lead to presence of multiple interacting diseases common
among older persons. For example, hypertension usually occurs with heart disease.
Acute illness can be superimposed on chronic illness, such as pneumonia on top of a
chronic lung disease like emphysema. Acute illness can also trigger affective disorders
such as confusion. The interaction of these diseases necessitates a more complex
assessment process. Signs and symptoms must be verified to determine whether or not
they are the result of an existing disease.

3. Expertise of the person doing the assessment and place and time where/when assessment
is done.
Techniques in Conducting an Assessment
1. The setting: privacy and comfort
Assessment should take place in a room where privacy, safety, and comfort can be
guaranteed. Most older persons are sticklers for privacy and modesty. "The person doing the
assessment must provide an atmosphere of confidentiality. Curtains and drapes must be used
for privacy. The older person must be made comfortable and safe during the conduct
of history taking and physical assessment. Furniture must be arranged in a way that will not
cause accidents and provide enough space for maneuvering wheel chairs or walkers. Seats
and examination tables must be designed to enable older persons with limited mobility or
painful joints to it or rise easily. The setting must be well lighted, not to bright or glaring.
Adequate lighting is needed since most older persons have poor eyesight. It must also b e
relatively quiet to facilitate good conversation. Distracting sounds or noise can be barriers to
communication. Unnecessary clutter must also be removed from the room to minimize visual
distractions, which can cause disorientation.
2. Establishing rapport: trust and respect. Establishing good rapport begins with respect.
Trust will be gained once respect is shown towards the older person. The health professional
should
always begin by introducing himself or herself by name and title. Then he or she should
explain the purpose for meeting with the older person and what will be done during the
interview and assessment. Respect can be shown by addressing the older person formally,
and once rapport is established, permission may be asked to use the older person’s first
name.
3. Communication techniques . good communication is at the heart of assessment: it entails
understanding of what is said, what is felt and what could help the other person. An
atmosphere of mutual respect should be established before the conduct of assessment.
4. Communicating with older persons with sensory impairment
At the beginning, of the session with an older person, ask if he/she wears
eyeglasses or a hearing aid and request that these be worn during assessment. Older persons
with poor eyesight must be assisted in answering written forms or when moving about the
room. For older persons with hearing impairment, it is important to provide nonverbal cues
during face-to-face communication. Some non-verbal cues include the speakers head
movements (acknowledgment, agreement); mouth movements (vowels, consonants) and eye
movements (attention, turn-taking.). It is also important that during the conversation, the
person speaking to the older person is facing the light, so that non-verbal cues are seen.
5. Communicating with older persons with cognitive impairment
Cognitive impairment may be in the form of confusion or dementia. These conditions can
make it difficult to carry on good communication with the older person. Confused persons will
have more difficulty focusing and are likely to be disoriented. Dementia is marked by memory
impairment. It is therefore important that some questions to the older person be verified
through the family or significant others. Some guidelines on how to communicate with a
confused and demented person are as follows:

Guidelines on Communicating with a Confused and/or Demented Person

1. Invest time in establishing rapport.
2. Always stress who you are and what your job is.
3. Remain pleasant, calm and supportive.
A. Minimize other sounds in the background like clocks, TV, radio etc.
5. Get inside the person’s attention bubble, by smiling or touching the persons hand.
6. Maintain physical and eye contact.
7. Ask the person to do one task at a time, breaking down complicated steps into simpler
ones.
8. Speak slowly and wait for the person to respond.
9. Keep the meeting short and gauge the response you get.
10. Expect slight suspicion or being thought of as family or relative

References:

Natividad, J.N.,Kuan,L.G.,Bonito,S.R.,and Balabagno, A.O.(2005). Caring for the Older Person