Comprehensive Elderly Assessment

Comprehensive Elderly Assessment
1. Health Perception-Health Management Pattern Perceptiona. History/interview/subjective assessment General

Describe health
Health maintenance/promotion practices

Perception on aging, health issues and self-care requirements self Exercise, diet, rest and stress management Tobacco, alcohol and drugs
Current health problems/management

Description of health problems and their management
Medications
Usage, rationale for use and side effects
Limitations
Impact of health problems and treatment modalities
Self-care Self Independence, assistance required
Advanced care planning

Advance directives, power of attorney, living will

b. Physical examination/objective assessment
Observe for indicators of effective health care management

Related to self-care measures; Observe overall appearance
Weight comparison
Compare with last documented weight and goal weight
c. Laboratory assessment (Hg A1c, up and go test) Glycosylated hemoglobin

Blood glucose control over the last 3 months
Up and Go Test
Mobility

2. Nutritional-Metabolic Pattern a. History/interview/subjective assessment
General How is your appetite? Has it recently changed? Dietary habits (RDA)
Food intake profile: 24-HR recall and 3 day diary Food intolerance and allergies
Difficulties
Ingestion: Chewing, swallowing, altered taste sensation, etc.
Weight
Weight gain or loss; perception of current weight
Hydration
Fluid intake
Other factors influencing intake

Underlying illness, medications, environmental factors and economic factors
Nutritional supplements
Vitamins, minerals, herbs, shakes, power bars

General appearance
Dry skin, alopecia, muscle weakness, pale conjunctiva, confusion
Anthropometric measurements (BMI)

Body Mass Index Value of BMI is not absolute in older population due to decreased muscle mass Older adults ( mild-moderate overweight) do not have the same CV risk factors of younger adults
Hydration/mucous membrane
Thirst sensation is often decreased with age Condition of mouth, tongue, mucous membranes, gums and teeth 30 ml of body weight (FORMULA FOR FLUID STANDARDS) 100ml/kg (FIRST 10 kg BW) then 50 ml/kg (NEXT 10 kg of BW) and 15 ml (ALL REMAINING kg BW) ACCURATE in older adults with low/high body wt.
Integumentary
Skin color, temperature, sensation and turgor
Cardiovascular musculoskeletal
Areas related to nutrition, including BP, pulse, assess for edema

b. Physical examination/objective assessment Observation
Eating behaviours, actual intake, preferences, ability to feed self and swallow food, position, comfort and time to finish the meal
c. Laboratory Assessment
CBC
Nutritional anemia
Hypoalbuminemia
Decreased protein stores, inflammation and injury
Decreased cholesterol
Decreased dietary intake
Prealbumin
Recent changes in protein status
TSH
Thyroid dysfunction

3. Elimination Pattern a. History/interview/subjective assessment
Urinary
General
Recent changes or problems with urination
Hydration considerations
Estimate urine output
Urinary incontinence
Urgency, amount and frequency Associated factors, management, ADLS
Urinary alterations
Indwelling catheter; self catheterization
Comprehensive Elderly Assessment Bowel

General
Recent change in bowel habits
Usual bowel function

Frequency, amount, color, consistency Incontinence, pain, straining
Bowel alterations
Ileostomy/colostomy Past and current bowel problems

Urinary Genitourinary assessment for older adults without symptoms Observe, percuss and palpate for distended bladder, palpate abdomen for pain In-depth genitourinary assessment for older adults with urinary symptoms MEN/WOMEN: UTI/CVA tenderness WOMEN: pelvic exam MEN: rectal exam Incontinence Contributing factors (medications, impaired mobility, cognitive impairment) Urinary alterations Color and clarity of urine Color, shape and size of stoma

Bowel Abdominal examination
IPPA
Rectal examination
Hemorrhoids, fissures
Bowel alterations
Colostomy (odor, color and consistency of the stool)
Medication review
Contributing factors
c. Laboratory/diagnostic tests Urinary (urine, serum tests)

Postvoidal residual (retention/incontinence) UA (UTI) Creatinine, BUN, PSA
Bowel (Guaiac, occult blood tests, sigmoidoscopy/colonoscopy)

4. Activity-Exercise Pattern
a. History/interview/subjective assessment
General
Participation in regular activities; limitations
Typical day
Typical day activity Activity patterns, sleep adequacy and rest periods Pain and fatigue
Physical activity
Activity patterns; limitations or changes
Assessment of ADLs
Independence; assistance
Limitations
Medical or physical problems

Driving assessment
License, accidents, violations, factors that may affect ability to drive
Cardiovascular
Hypertension, angina, numbness/tingling of extremities
Respiratory
Lung or breathing problems; allergies
Musculoskeletal
Problems that can affect mobility
Falls
Concerns; assistive devices, RF, environmental hazards, environmental modifications
Social/recreational activities
Interest or hobbies

b. Physical examination/objective assessment Vital signs
VS at rest, after moderate and vigorous exercise BP and HR in supine and standing positions
Cardiovascular
Capillary refill, apical, radial and peripheral pulses, edema
Respiratory
Respiratory pattern (rate, depth, rhythm and type)
Musculoskeletal
Symmetry, mass, tremor or spasms, ROM, strength and tone
Balance/coordination/gait
Sitting and standing; ability to stand transfer and ambulate assistive devices, coordination

4. Activity-Exercise Pattern
b. Physical examination/objective assessment Assessment of ADLs

Level of independence and assistance
Driving assessment
Visual and hearing deficits, cognitive, neurologic and musculoskeletal systems
Fall assessment
Gait, balance, muscle strength, medications, cardiovascular status FALLS ARE ASSOCIATED WITH SIGNIFICANT MORBIDITY AND MORTALITY RATES IN OLDER ADULTS

c. Laboratory and diagnostic tests (CBC, CXR, ECG, Cardiac exercise stress test, Osteoporosis screening) CBC WBC Pulse Oximetry CXR Cardiac Stress Test cardiac risk factors Osteoporosis screening (bone density test) - >65 women and at age 60 for high risk

5. Sleep-Rest Pattern
General
Do you feel rested after sleeping?
Current patterns
Sleep time, Arousal time, nap frequency and duration
Changes
Sleep pattern, difficulty sleeping, contributing factors
Sleep routines
Sleeping aids, bedtime rituals, environmental factors
For sleep difficulties Sleep/wake diary

to record naps, sleeping duration, dreams, awakening, effectiveness of bedtime aids
Family observation of sleep-rest patterns

Noting positioning, movement, restlessness, snoring

Observation
Adverse impact of sleep patterns or sleep medication
Medication review
c. Diagnostic testing
Sleep study
Unresponsive to conservative measures

6. Cognitive-Perceptual Pattern
Cognition Memory
Forgetfulness (sudden/gradual, minor or major events); Causes (illness)
Communication
Difficulties in articulation, forming ideas, sensory deficits, memory impairment
Orientation
Time, day, year Familiar people and places
Functional considerations
Cognitive impairment
Perception Sensory systems

Changes in sensory function (visual, hearing, tactile, smell or taste)

Pain assessment
Subjective PQRST

Cognitive assessment
Level of consciousness Standardized mental status exam Communication style and factors that affect communication
Sensory examination
VISION, OLFACTORY, AUDITORY, TACTILE, GUSTATORY, KINESTHETIC
Pain assessment
Type of pain (somatic, visceral and neuropathic) and etiologies PQRST Coping measures

7. Self-Perception/Self-Concept Pattern
General
How do you feel about yourself as a person?
Self-perception
Self acceptance and recognition of self-worth
Affective/psychological assessment Symptoms

Prolonged sadness, worthlessness, guilt Coping methods
History
Depression, anxiety and other psychological disorders and treatment
Goals
Plans to achieve the goals

Psychosocial development
Ego integrity vs. Self despair
Affective/psychological assessment Screening (Geriatric Depression Scale)

At least annual screening for depression Preferred screening tool
Goals
Identify at risk for depression or suicide Maintain a high index of suspicion for both depression and suicide risk

8. Role-Relationship Pattern
a. History/interview/subjective assessment General How would you describe your role within your family and community? Roles (FORMAL AND INFORMAL) Family Marital status, family situation, living arrangements and financial situations Friends/community Involvement with people or community groups Relationships/socialization Family Family decisions, relationships, crisis Environmental factors Distance, means of communication and transportation

Destructive relationships/elder mistreatment
OLDER POPULATION IS A VULBERABLE GROUP RISK FACTORS FOR ABUSE
Abuse
Safety at home, ambivalent feelings, coping strategies
Violence
Victim of crime or interpersonal violence
Neglect
Assess if needs are met, relationship with caregiver, nutrition and hygiene
Self-neglect
Self-care ability, safety, cleanliness

b. Physical examination/objective assessment Observation
Social patterns and relationships
Role assessment Caregiver

Caregiver burden
Care recipient
Mistreatment
Elder mistreatment examination THREE SITUATIONS:

Unusual injuries Multiple RF for elder abuse or neglect High index of suspicion
Comprehensive Elderly Assessment Elder mistreatment examination General survey

Personal hygiene
Screening
Cognitive impairments and functional deficits
Physical examination
Bodily injury

9. Sexuality-Reproductive Pattern
Introduction Belief and expectations (male and female)
Sexual difficulties or changes, illness or medications that affect sexual activity
Sexually active (men and women)

Gender, no. of past and current partners, type of intercourse, changes un sexual activity

Pay attention to verbal and nonverbal congruency
Satisfaction; concerns
Problem-focused physical examination

Testicular/pelvic exams STD

10. Coping-Stress Tolerance Pattern
General
Overall stress level
Stress assessment
Current causes and contributing factors
Stress management/coping
Praying, meditation, indulgence in food, cigarettes, alcohol
Loss
Recent actual or perceived loss

Range of coping skills and their effectiveness

11. Value-Belief Pattern
Introduction
Explanatory statement
Values/beliefs
Role of spirituality in ones life
Barriers
Lack of transportation, attire, altered mobility, sensory deficits
Internal conflict
At end of life, issues may play an important role in decision-making
Open-ended question

Documentation
Spiritual concepts that affect administration of health care
Spiritual distress
Referral to spiritual counselor or clergy

Comprehensive Elderly Assessment

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Comprehensive Elderly Assessment

1. Health Perception-Health Management Pattern Perceptiona. History/interview/subjective assessment General

Health maintenance/promotion practices

Current health problems/management

Self-care Self Independence, assistance required

Advanced care planning