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Gerontological Nursing 2 credit undergraduate course Page 5 of 20

Week 2: Nursing assessment of the older adult

Learning objectives: Describe how the nature of illness presentation, changes in homeostatic mechanisms and the lack of normative standards for older adults affect the assessment process Explain rationale for conducting assessments of functional status in older adults and considerations for baseline comparisons Describe elements of general assessment and useful assessment tools Discuss rationale for integrating findings from physical, psychosocial, functional, and environmental assessments

Lecture/discussion:

  • 1.

    Overview: steps to assessment

    • a.

      Assume heterogeneity

    • b.

      Use elder‟s previous status as baseline for setting unique, individualized standard

    • c.

      Differentiate normal age-related changes from disease states

      • i.

        Prevention, early detection, proper intervention, proper evaluation of treatment effects, identification of adverse reactions/side effects

  • 2.

    Assessment considerations

    • a.

      Altered/atypical presentation and response to specific diseases (i.e., modified, unrelated, absent)

    • b.

      Functional status

    • c.

      Cumulative and integrated effects of multiple losses: psychosocial/physiologic conditions, functional changes

      • i.

        Short term/long term functional implications (ADLs, IADLs)?

      • ii.

        Failure to thrive what is this? Multi-layered, multi-dimensional

    • d.

      Socio-cultural, environmental, economic, physiologic, psychologic

  • 3.

    Assessment challenges

    • a.

      Standards for “normal aging”

    • b.

      Absence of norms for many pathological conditions

    • i.

      Atypical presentations

    • c.

      Landmarks for development after 65? Are they the same at ages 75, 85, 90?

    • d.

      Baseline for functional status

  • 4.

    Assessment tools (general)

    • a.

      Try this: Best Practices in Nursing Care of Older Adults

i. ii. iii. iv. v. vi .

Fulmer SPICES: An Overall Assessment Tool of Older Adults Katz Index of Activities of Daily Living Beers‟ Criteria for Potentially Inappropriate Medication Use in the Elderly Predicting Pressure Ulcer Risk Fall Risk Assessment Nutritional Assessment?

Permission is hereby granted to reproduce, post, download, and/or distribute, this material for not-for-profit educational purposes only, provided that Northwest Coalition for Geriatric Nursing Education is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDF format. Available on the internet at www.geronursinged.org E-mail notification of usage to: soncgne@ohsu.edu

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