Lecture #4

Question 1

What do the health assessments of older adults include?

Answer 1

physical data
biological
cultural– religion, beliefs, practices
psychosocial – family, relationship, social activities
functional aspects – physiological and anatomical
growth and development

Question 2

what is the nurse required to do in effective assessment of older adult?

Answer 2

listen patiently
allow for pauses
ask questions
observe minute details
obtain data from all sources
recognize normal changes associated with late life

ask open-ended questions and give them a min to answer
dont jump around and make sure they understand
make sure you are fully assessing the PT; make sure to get all data bc you don’t know if they will need to be taken for labs, etc.

Question 3

what are the health history components?

Answer 3

past medical history
review of symptoms
med history: prescription, OTC, herbs and supplement
social history: live arrangements, resources, and support systems

Make sure to get all medications that the patient is taking; even if they don’t know the name but know the color and what it looks like
Make sure their home is functional; stairs, levels, rugs, etc.

Question 4

What are important components for older adults?

Answer 4

self-report of functional status
home assessment
psychological aspects: cognitive and emotional
roles: caregiver, family structure
decision: makes in family

Cannot do what they use to do; example = cannot drive bc they had their keys taken
See what kind of role they play in the family
They keep the family together bc they are the oldest
What do they do during the day so you can know the important roles they play.
See if they are the decision makers in the family

Question 5

What are other components; difficult and sensitive?

Answer 5

1. sexual dysfunction
2. depression
3. incontinence
4. alcoholism
5. hearing loss
6. memory loss or confusion
7. Make sure you are educating them on their decrease in libido
8. Check for depression, you can tell when the patient is depressed
9. Make sure you let them know that incontinence comes with aging, let them know about the briefs/pads they can get
10. Make sure they know some of their medications you cannot drink alcohol with them
11. Slow down and talk slower with the elder population
12. Reorient the patient, make sure they know the time, day, etc.

Question 6

what consist in a culturally sensitive assessment?

Answer 6

how would you describe…
how long…
what do you think…
why do you think…

Be sensitive to the patient
Make sure you know how you will describe different things to the patients
Make sure you always assist them with their culture, learn different things about cultures
We cannot say we don’t know, we turn off what we know and work with them in understanding their culture

Question 7

FANCAPES assessment:

Answer 7

fluids
aeration
nutrition
communication
activity
pain
elimination
social skills

Question 8

SPICES assessment:

Answer 8

sleep disorders
problems with eating/feeding
incontinence
confusion
evidence of falls
skin breakdown

Question 9

Why assess? functional assessment

Answer 9

where is helped needed
changes over time
what specific services
determination of safety

Question 10

ADLs? functional assessment

Answer 10

task of self care
needed to maintain one’s health
tool: Katz (6 = hight patient is independent and 0 = patient is highly dependent on another person)

Question 11

IADLs –instrumental activities of daily living? functional assessment

Answer 11

task for independent living
needed to maintain one’s home
tool: Lawton (daily living scale)

Determine how dependent the patient will be on their own
Determine if they can function
Might need a good PROPER bath once a week even if they can do it on their own
Make sure to ask the patient if they can do it themselves, be their for assistance
Make sure to ask these questions, make sure to ask what they independently do at home

Question 12

What is considered in the mini-mental state examination (MMSE)?

Answer 12

screen for and monitor cognitive function
gross screening of dementia – rule – out not diagnosis
test: orientation, short-term memory and attention, calculation ability, language and construction
30 items
must be able to read, write and be english proficient

Make sure the patient is cognitive
When using it also known as the SLUMS
Both used how they are cognitive and what they understand
Checks their memory state
Give them different words to say, what a clock looks like, ect.
Make sure you have what you are going to use before walking in the room

Question 13

What does the clock drawing test (CDT) screen for?

Answer 13

screen and diagnose dementia
not for MCI
manual dexterity and visual acuity required (not appropriate for blind, Parkinson’s disease, stroke, sever arthritis)
directions: provide white plain paper with circle drawn on it, 5 in diameter and ask person to draw numbers in the circle so that it looks like a clock and then put hands to read “10 after 11”
Make sure you pay attention on how they draw the clock

Question 14

What is the CDT scoring?

Answer 14

a score of 1 or 2 is considered normal

a score of >3 represents a cognitive deficit

Question 15

What is a mini-cog and its directions?

Answer 15

screens for MCI and dementia
equivalent to MMSE
combination MMSE and CDT
short-term memory and executive function
must hear, hold pencil, write numbers

directions:
step 1- say 3 unrelated words, clearly, 1 second each
ask person to repeat these

step 2- ask person to draw a clock as in clock drawing test

step 3 - ask person to recall the 3 words from step 1

Tells what their cognitive function is
3-5 negative for dementia

Question 16

What is done in an assessment of mood?

Answer 16

Important to assess mood
Untreated depression = more functionally impaired, prolonged hospitalizations, decreased QOL, increased morbidity

Tools to assess mood:
Geriatric Depression Scale
Centers for Epidemiologic Studies Depression Scale
Cornell Scale for Depression in Dementia

Assess mood of patient early
Higher the rate of older population, seeing more friends going to the hospital which can cause depression bc they see that it can happen to them too.
They will begin to feel lonely, and will get into a depressed state
Assess if they are depressed?
Need to be around another group of friends
Check for their mood

Question 17

What is the OARS- older American resources and services assessment questionaire?

Answer 17

Divided and scored in 5 sub-scales:
Social resources
Economic resources
Mental health
Physical health
ADLs

Aids in establishing degree of need
Rating – Excellent to Completely Impaired

Question 18

What is a comprehensive assessment tool example?

Answer 18

Patient completes answer questions about:
Background
Daily activities
Nutritional status
Overall health
Medications
Other medical conditions
Social activities
Mood
Social support
Global health measures (via Likert Scale)
Health behaviors

This is part of your complete assessments, make sure you are getting this assessment done!
Make sure you are looking at all this

Question 19

This is part of your complete assessments, make sure you are getting this assessment done!
Make sure you are looking at all this

Answer 19

physical vulnerability

A safe environment allows an older person to live without fear of attack, accident, or imposed interference

Decreased sensory deficits can impair the individual’s awareness of dangerous conditions or imminent threats

Make sure patients are sitter free for 24 H so they can go to a nursing home/facility
If you hear a bed alarm going off, make sure you are checking on patient and seeing what is going on with the patient, you do not want them to fall
Make sure their surroundings are safe/clear
Make sure everything is in their reach
Older patient for bed alarms
Always watch patient safety areas

Question 20

What are home safety evaluation problems and interventions?

Answer 20

1. bathroom
2. bedroom
3. kitchen
4. living room
5. telephone
6. steps
7. home management
8. safety
9. leisure

Assess the patients room and make sure the patients family hasn’t taken anything that they don’t need to have in their room
Make sure their locks work
Make sure they can get what they need out of their cabinets

Question 21

Thermoregulation: neurosensory changes?

Answer 21

diminish or delay perception of environmental temperature changes

Question 22

Thermoregulation: physiological changes

Answer 22

impair cooling and warming responses to environmental temperature changes

Question 23

Thermoregulation: medications and alcohol

Answer 23

impair vasomotor response, inhibit neuromuscular activity, suppress metabolic heat generation, and/or dull awareness of surroundings

Changing with the older population
Impairing them to control their body temp.
Be aware of what they are putting in their system that can cause body temp changes

Question 24

what are the temperature vulnerability factors?

Answer 24

Caretakers/family
Monitor individual who has cognitive or physical limitations that affect ability to respond to changes in temperature

Economics
When an older person cannot afford proper heating or air conditioning

Safety concerns might prompt older adults to bolt doors and windows, creating unsafe temperature in home environment

We need to put on or take off clothes before the patient does
Follow what the patients wants for the temp in a room
Make sure it is always safe for the patient
Make sure the window has a protectant on the other side (keep mentally changed/depressed patients in the room) the window will be the first way they will go
Watch the patients with ALZ and dementia
Always check everything including their surrounding

Question 25

Temperature monitoring?

Answer 25

Diminished thermoregulatory response impairs ability to respond to infection with fever
Frail older adults have lower baseline temperatures than younger adults
Absence of fever does not rule out infection; a one degree change from baseline may be significant in older adults
High fevers (≥ 38.3 ̊ C/100.9 ̊ F) are serious and associated with bacterial and viral infection

Question 26

Hyperthermia?

Answer 26

More older adults DIE from excessive HEAT than from all other natural disasters combined
Elderly are not likely to turn their air conditioning on during the summer

Question 27

What is the hyperthermia progression?

Answer 27

heat fatigue –> temp = norm –> pale/diaphoretic –> elevated HR

heat exhaustion –> temp norm or mild evaluation –> cool and clammy –> tachycardia, thirsty, AMS, nausea, cramping

heat stroke –> medical emergency with high morality in older adults

temp-quickly elevates to > 104 degrees –> flushed hot & DRY –> tachycardia, MS change, hypotension, hyperventilation –> cellular and organ damage

Can’t get their organs back down to be cool enough; have to get the inside of their body cool
Checks are Rosey and they are sweating = can be temp or Blood sugar levels

Question 28

hyperthermia prevention:

Answer 28

drink (2-3 L of cool fluids daily: as tolerated)
minimize (minimize exertion, esp. heat of day
stay in (stay in air conditioned, or use fans
wear (hats and loose clothes when outside; remove most clothing when indoors)
take (take tepid baths or showers)
apply (cold, wet compresses, or immerse hands and feet in cool water)
evaluate (meds for risk of hyperthermia)
avoid (alcohol)

Make sure they are wearing the proper amount and color in clothing when going outside exercising and/or exercising in general
Elders refuse to turn on their air; make sure the fan is drawing out the right amount of air

Question 29

What do you need to know about hypothermia?

Answer 29

nearly 50% of hypothermia deaths occur in older in older adults
mild, moderate, or sever depending on core temp
first sign may be confusion and disorientation
defined as core temp < 35 (95 degrees F)
can occur w/ exposure to extreme cold environmental conditions or exposure in room temp without protection
goal: temp >97 degrees F

Greater the 97 degrees but not over 100 degrees
Make sure to watch in all patients

Question 30

What are risk factors for hypothermia?

Answer 30

impaired circulation
DM
adrenal or thyroid dysfunction
malnutrition
excessive alcohol use
inadequate housing or supervision
use of sedatives, anxiolytics, anti-depressants

Finger not bleed enough in acucheck, bc they have neuro problems in their fingers
Make sure they aren’t excessively using alcohol
Safety space heaters for the patients
Watch the medications and make sure to teach them about their medications when giving it to them so they know what to look for

Question 31

What are health promotion thermoregulation?

Answer 31

recognition of clinical signs of hyperthermia and hypothermia
monitoring of body temps against baseline in older adults
establish surveillance system for community dwelling older adult clients
social service referrals for assistance with heating and electrical bills

Temp 99 ; when charting we can check the patients baseline
Contact social workers if they need help paying for stuff at home

Question 32

What are risks and vulnerability?

Answer 32

Living alone
Memory impairments
Loneliness
Older people are more likely to be victims of consumer fraud and scams that include telemarketing fraud, e-mail scams, undelivered services

Question 33

what are fraudulent schemes against elders?

Answer 33

Trusting elderly persons may be duped into giving money to pen pals, Internet acquaintances, phony religious causes, new acquaintances who “need help”
Door-to-door contractors
IRS Impersonators
Medical fraud

Make sure to educate the family members about checking on the their elder family member
Let them know what is going on in the world
Make sure you are at the house when your elderly family member is having someone over to check them

Question 34

What are fire safety risk factors?

Answer 34

Economic or climatic conditions may promote use of ill-kept heating devices
Attempts to cook over open flame while wearing loose-fitting clothing
Inability to manage spattering grease from frying pan can often start fire from which elder cannot escape

Ex: grease at the right temp
Make sure they are turning off the oven
Educate them on doing one thing at a time

Question 35

What is transportation safety?

Answer 35

Critical for the older adults to remain independent and functional

Limited access to safe transportation contribute to:
Social isolation
Poor nutrition
Neglect of health

Area agencies - Provide information and resources to help older adults with limited transportation accessibility

Already isolated, they want to use their friend or family member to drive them
Make sure they are good transportation services; not a sketchy, non-registered transportation service

Question 36

What are safety concerns for driving?

Answer 36

Loss of driving privileges due to physical limitations or dementia
Not always individual’s choice
A life-changing event contributes to
Social isolation
Increased depressive and anxiety symptoms
Decreased quality of life
Increased risk of nursing home placement
Associated with loss of autonomy, pleasure, competence, and self-worth
Must include plan for alternate transportation with family, caregivers, or community resources

Loose drivers licenses bc of certain medications
Make sure to explain to the patient why they cannot drive!
Let them know that you aren’t taking it away just to take it away, educate them on why you are taking it away!
To keep them safe when driving

Question 37

What are some safe driving tips?

Answer 37

SAFE DRIVE mnemonic (Box 20.11)
Plan travel route in advance; Map or GPS
Wear seat belt
Keep eyes on road
Avoid distractions
Cell phone - pull over
Follow 4-second rule when following another vehicle
Obey traffic and motor vehicle laws, signs, signals

Adjust speed to road and weather conditions
Drive with doors locked, windows rolled up
Park car in visible, well-lighted area
Expect the unexpected and always drive defensively
Vehicle adaptations and safe driving programs are available and promote safe driving

Don’t turn the phone back on till they get to a stopping point, color blind = make sure to take their keys, so they can see the light changes

Question 38

What is the role of assistive technology?

Answer 38

Gerotechnology term used to describe assistive technologies for older people
“Smart Homes”
Telemedicine & “smart medical homes” - monitor gait, behavior, & sleep
Remote-control monitoring systems – auto lights, watering plants
Motion and pressure sensors – detects movement
Facial recognition and memory aids
Make sure to educate them on how to use their technology