Assessment of Health and Functioning in Older Adults

Question 1

Gerontology

Answer 1

Study of aging and older adults

• Focus: healthy and successful aging
• Address diversity among older adults

Question 2

Geriatrics

Answer 2

Focuses on medical problems of older adults

• Shifted its focus from curing to caring
• Emphasis on quality of life

Question 3

Positive Functional Consequences

Answer 3

Those that facilitate highest level of
functioning, least dependency and best
quality of life.

Question 4

Functional Consequences

Answer 4

Observable effects of actions, risk factors
and age-related changes that influence
quality of life or day-to-day activities of
older adults.

Question 5

Age-Related Changes

Answer 5

Inherent physiological processes that
increase vulnerability of older adults.

Question 6

Negative Functional Consequences

Answer 6

Those that interfere with older adult’s
functioning or quality of life.

Question 7

More about Age-related Changes

Answer 7

Inevitable, progressive and irreversible changes that happen to everyone.

• Physically degenerative
• Psychological and spiritual potential for growth

Question 8

Risk Factors

Answer 8

Conditions that increase vulnerability

• Disease
• Environment
• Lifestyle
• Support systems
• Psychosocial circumstances
• adverse medication effects
• attitudes based on lack of knowledge

mnemonic: DELSPAA

Question 9

Health

Answer 9

individual’s experience of sense of well-being, harmony and unity

Question 10

Wellness

Answer 10

ability of older adult to function at highest capacity, despite the
presence of age-related changes and risk factors

Question 11

Health Promotion:

Answer 11

programs or interventions that focus on behavior changes
in relation to environment

Question 12

Environment

Answer 12

external conditions that impact health and wellbeing

Question 13

How does an older adult stay well? Health promotion activities

Answer 13

• Prevention and screening
• Risk-reduction interventions
• Environmental modifications
• Health education

Question 14

Continuum of care - Community

Answer 14

• Health promotion
• Respite services
• Adult day centers

Role of the nurse:
- Education
- Referrals

Question 15

Continuum of care - Home Care

Answer 15

• Goal is rehabilitation
• Meal prep, personal care, errands, light housekeeping

Role of the nurse:

• Education
• Referrals
• Assessment
• Care planning
• Hands-on care

Question 16

Continuum of care - Nursing Home

Answer 16

• Need 24 hr assistance with ADLs

Role of the nurse:
- Education
- Referrals
- Assessment
- Care planning
- Hands-on care
- Continuous on-site responsibility
- Coordinates with interprofessional

Question 17

How does the nurse know which type of care an older adults needs?

Answer 17

Nursing assessments are done in any setting in which an older adult lives.

Question 18

Types of Assessment

Answer 18

• Physical assessment
• Functional Assessment
• Mental Status assessment
• Comprehensive Geriatric assessment
• Environmental and safety Assessment
• Other assessment

Question 19

Nursing Assessment Tool

Answer 19

To identify specific areas that need to be addressed in the Nursing care plan

Should be:
- Evidence based
- Easy to use

Question 20

Interviewing Older adults

Answer 20

Preparing the physical setting
- Noise, lighting, comfortable furniture, privacy, bathroom

Establishing rapport
- Use formal names
- Explain the purpose
- Speak directly to the older person
- Maintain modesty standards set by each culture

Question 21

Interviewing older adults: Structuring the Interview

Answer 21

• Brief interactions less than 30 minutes each
• Avoid Medical Jargon
• A summary of restatement
• Prepare the older person for the end of the interaction

Question 22

Physical assessment

Answer 22

• Obtain the health history before starting physical assessment
• Head to toe (observational)
• Measuring vitals signs in older adults
  - Temperature
  - Pulse
  - Respirations
  - Blood pressure
  - Orthostatic pressure

Question 23

Functional Assessment

Answer 23

• Refers to measurement of person’s ability to fulfill responsibilities
  and perform self-care task
• It should measure primarily
  • Activities of daily living (ADLS)
  • Instrumental activities of daily living (IADLs)
  • Level of assistance needing (ie. independent, semi-
    independent, dependent)
  • Sensory function (ie. vision/hearing, etc.)
  • Cognitive function (baseline mental status)

Question 24

Common Functional Assessment tools

Answer 24

• The Katz Index of ADL’s
• 48/6

Question 25

Mental Status Assessment

Answer 25

Assessment regarding cognitive ability and mood - CAM - Mini-mental state Examination (MMSE) - Geriatric Depression Scale (GDS) - Cornell scale for Depression in Dementia (CSDD)

Question 26

Comprehensive Geriatric Assessment

Answer 26

-SPICES S is for Sleep Disorders. P is for Problems with Eating or Feeding. I is for Incontinence. C is for Confusion. E is for Evidence of Falls. S is for Skin Breakdown. - Minimum DATA Set (MDS)

Question 27

Environmental and Safety Assessment

Answer 27

- Fall Risk Assessment - Braden scale

Question 28

Health Assessments in Older Adults: Why are they so complicated

Answer 28

- It is common to have more than one chronic and acute issue - Manifestation of illness or adverse medication effects tend to be obscure, less predictable. - For every change, there may be multiple possible causes. - Treatment often directed at symptoms not source of problem. - Cognitive impairments affect accurate reporting. - Myths may lead older adults or support people to falsely attribute treatable conditions to “normal aging”

Question 29

In what setting do Older Adults experience the most functional decline? Hospital Home Long term Care facilities They experience functional decline equally in all settings

Answer 29

Hospitals

Question 30

Functional decline occurs due to transitions in care

Answer 30

- Communication gaps - Poor client education - Unique patient characteristics (Language barrier, culture) - Incomplete transfer of information - poor med rec procedures - low staffing

Question 31

Which intervention most closely aligns with the practices of health promotion? Question 1Select one: a. Providing presurgical teaching to an older adult prior to hip replacement b. Leading a flexibility and mobility class among older adults c. Administering medication to an older adult with osteoarthritis d. Teaching an older adult how to administer her inhaled medications independently

Answer 31

Leading a flexibility and mobility class among older adults

Question 32

A hospital nurse is discussing with an older adult the possibility of transfer to a nursing home for skilled care after pneumonia. Which statement by the client indicates an understanding of this possible transfer? Question 2 Select one: a. Old people who go to the nursing home don't get out. b. They will take my home if I go to the nursing home. c. My pneumonia enables me to qualify for skilled care in a nursing home. d. I don't qualify for skilled care; I only had pneumonia.

Answer 32

My pneumonia enables me to qualify for skilled care in a nursing home

Question 33

A nurse is teaching a family of an older adult about the role of adult day centers. Which of the statements by the family member indicates a need for further teaching? Question 3Select one: a. “The day center can contribute to an actual improvement in dementia symptoms.” b. “The day center can give me respite.” c. “The day center can be a useful alternative to medical care.” d. “The day center can improve our quality of life.”

Answer 33

“The day center can be a useful alternative to medical care.”

Question 34

An 84-year-old client has been living in an assisted living facility for several years but is now faced with the prospect of relocating to a nursing home. Which of the following characteristics of the client's current situation is most likely to prompt this move? Question 4 Select one: a. The development of a severe, acute health problem b. Exacerbation of a chronic health problem that may require medical treatment c. A change in the level of the client's social support d. A decrease in the client's level of function and activities of daily living (ADLs)

Answer 34

A decrease in the client's level of function and activities of daily living (ADLs)

Question 35

Active care management is often necessary in order to maintain wellness among older adults. Which older adult is most likely to require care management? Question 5Select one: a. 77-year-old woman who enjoyed good health until she suffered a severe stroke 3 days earlier b. 90-year-old man who lives alone and has no living family members c. 81-year-old resident of a nursing home whose Alzheimer disease is progressing rapidly d. 90-year-old man who has recently been transferred from an assisted living facility to an acute care setting

Answer 35

90-year-old man who lives alone and has no living family members

Question 36

A gerontological nurse is aware that out-of-pocket expenses for care can be onerous for many older adults. Which action can the nurse take to potentially minimize these expenses for clients? Question 6Select one: a. Provide care that is primarily focused on acute, rather than chronic, health problems. b. Encourage older adults to make care providers aware of each chronic condition they live with. c. Teach older adults to be astute with their spending and saving patterns. d. Become familiar with the various funding sources and their eligibility requirements.

Answer 36

Become familiar with the various funding sources and their eligibility requirements.

Question 37

Admission to long-term care is typically a culmination in a long series of health problems and functional limitations. Which problem is most likely to precipitate admission to long-term care? Question 7Select one: a. Chronic kidney disease b. Traumatic Injury c. Terminal cancer diagnosis d. Dementia

Answer 37

Dementia

Question 38

A nursing administrator of the long-term care facility starts a quality of life improvement program for older adults. Which activity should be included in the program? Question 8Select one: a. Divide the residents according cognitive ability. b. Assess personal choices. c. Emphasize safety and medical care. d. Decrease the use of pain medications.

Answer 38

Assess personal choices.

Question 39

Older adults with complex medical problems are vulnerable to experiencing problems as they transition between care settings. All of these factors compromise client safety except one. Question 9Select one: a. Ineffective medication reconciliation procedures b. Client age c. Communication gaps d. Client characteristics e. Poor coordination of services

Answer 39

Client age

Question 40

A nurse is responsible for assessing an older adult in an acute care setting. Which statement most accurately captures the complexity involved in assessing the older adult? Question 10Select one: a. Older adults experience fewer acute health problems but more chronic illnesses than do younger clients. b. Signs and symptoms of illness are often obscure and less predictable among older adults. c. Care must be taken to avoid assessing normal, age-related changes. d. Older adults manifest fewer symptoms of illness than do younger clients.

Answer 40

Signs and symptoms of illness are often obscure and less predictable among older adults.