GERONTOLOGICAL ASSESSMENT ALTERED PRESENTATION and response to specific

diseases
*Age specific approach UTI
 Dysuria often Absent, frequency, urgency, nocturia
INTERRELATIONSHIP BETWEEN PHYSICAL AND sometimes present, incontinence, delirium, falls and
PSYCHOSOCIAL ASPECTS OF AGING anorexia are other signs

Factors: MI
 Reduced ability to respond to stress  no chest pain, atypical pain location such as in jaw,
 Physical changes and loss of functional ability neck, shoulder, epigastric area. Dyspnea may or may
not be present, other signs: tachypnea, arrythmia,
EFFECTS OF SELECTED VARIABLES ON FUNCTIONAL hypotension, restlessness, syncope, and fatigue and
STATUS weakness, Fall may be prodrome
 Visual and auditory loss :
 Apathy, confusion, disorientation, loss of Bacterial Pneumonia
control, dependency, confusion, agitation  cough may be productive, dry or absent, WBC
 Multiple strange and unfamiliar environment elevated
 Dependency, loss of control, sleep disturbance,
relocation stress CHF
 Acute medical illness  anorexia, restlessness, delirium, cyanosis and falls
 mobility impairment, dependency, loss of
control, sleep disturbance, pressure ulcer, Hyperthyroidism
inadequate food intake.  Slowing down (apathetic hyperthyroidism) lethargy,
 Altered Pharmacokinetics and pharmacodynamics weakness, depression, atrial fibrillation, CHF.
 persistent confusion, drug toxicity, potential for
further mobility impairment, loss of function, Hypothyroidism
and altered bowel and bladder function  subclinical symptoms: delirium, dementia,
Kinetics –action of drugs depression, lethargy, constipation, weight loss,
Dynamics – effects muscle weakness/ unsteady gait.

 Loss of appetite: Depression

 wound healing, bowel function and energy level,  memory concentration, cognitive and behavioral
dehydration and sleep disturbance changes, increased dependency, anxiety and
increased sleep, muscle aches, be alert for CHF, DM,
NATURE OF DISEASE AND DISABILITY AND THEIR EFFECTS cancer, infectious diseases and anemia.
ON FUNCTIONAL STATUS Cardiovascular agents anxiolytics, amphetamines,
narcotics and hormones.
Indicator of functional impairment:
 Lethargy Tailoring the Nursing Assessment to the older person
 Incontinence
 Decrease of appetite Preparation of the Environment:
 Weight loss  Space – consider mobility aids, Noise – minimize,
Temperature,Lighting – diffuse, not directional or
FACTORS: localized
 Decreased efficiency of homeostatic mechanism  Surfaces – not glossy and highly polished, Seating
 Weakened IMMUNOCOMPETENCE position,Bathroom – proximity to it, Water – or any
 Lack of standards for health and illness norms other fluids for drinking, Privacy, Energy level,
 Laboratory values (FBS) Patience, Time, Signs of fatigue – sighing, grimacing,
irritability etc.

Guidelines to assessing functional limitations:

 Assess more than once and at different times of day.
 Measure performance under the most favorable
conditions
 Take advantage of natural opportunities that would Dimensions of a Symptom
elicit assess and capabilities; collect data during  Location
bathing, grooming and mealtime.  Quality or character
 Ensure that assistive sensory devices and mobility  Quantity of severity
devices are in place  Timing
 Interview family, friends and significant others  Setting
 Use body language  Aggravating or alleviating factors
 Be aware of client’s emotional state and concerns  Associated symptoms

THE HEALTH HISTORY Physical Examination

 The nursing health Hx and interview  Objective information
 1st phase of nursing-focused health assessment  Typically perform after health history
 Provide subjective account  It allows the nurse to:
 Basis for therapeutic relationship  Determine client strengths and capabilities
 Should also include functional, cognitive,  Verify and gain objective support for subjective
affective and social well-being. findings
 Gather objective data not previously known
The Interviewer  Head-to-toe approach – generally most efficient
 ATTITUDE – a feeling, value, or belief about  Affected by practice setting and client condition
something that determines behavior.
 A successful interview: General Guidelines in PE
 Give the reason for the interview  Recognize that the older adult may have no
 Goal-oriented interviewing previous experience with a nurse performing a
 Guided reminiscence PE
 Set a time limit  Be alert to clients energy level – most important
 Mutually establish goals with the client parts first
 DISTANCE  Respect modesty
 Therapeutic touch  Keep the client comfortably draped
 Improvise  Sequence the examination to keep position
changes to a minimum
The Client  Ensure comfort
 Visual deficit  Explain each step in simple terms
 Hearing deficit  Be gentle
 Anxiety  Probe painful areas last
 Decreased energy level  Share findings to patients when possible
 Pain  Take advantage of “teachable” moments
 Multiple and interrelated health problems  Develop standard format on which to note
 Tendency to reminisce selected findings

The Health History Format Additional Assessment Measures

 Client Profile/Biographic Data  Functional Status Assessment
 Family Profile  FUNCTIONAL STATUS is significant component of
 Occupation Profile an older adult’s quality of life
 Living Environment Profile  An essential piece of the overall clinical
 Recreation/Leisure Profile evaluation of an older person
 Resources/Support System Used  ADLs and IADLs
 Description of a Typical Day  An assessment tool for example is Katz Index of
 Present Health Status ADLs – measures ADLs in terms of bathing,
 Past Health Status dressing, going to toilet, transfer, continence,
 Family History and feeding. This order of items reflects the
 Review of Systems progression of loss and restoration of function.
 Cognitive Assessment  Primary prevention – measures provided to
 To determine the client’s level of cognitive individuals to prevent the onset of a targeted
function and the effect of the degree of condition.
impairment on functional ability.  Secondary Prevention – activities which identify and
 Assessment tools: SPMSQ (Box 4-9), MMSE (Box treat asymptomatic persons who have already
4-10), MiniCog (Box 4-10) and Geriatric developed risk factors or preclinical disease but in
Depression Scale for depression whom the disease is not clinically apparent.
 Tertiary Prevention – activities that involve the care
Exam Components: General Appearance, Alertness. of established disease with attempts made to restore
Mood or affect, Speech, Orientation, Attention and the person to highest function, minimize negative
concentration, Judgment, Memory, Perception and effects of disease and prevent disease related
Thought content and processes. complications.
 Quaternary prevention – involves limiting disability
 Social Assessment caused by chronic symptoms while encouraging
 Reasons for screening social function: efforts to maintain functional ability or reduce any
 It is correlated with physical and mental loss of function through adaptation.
function
 Social well being positively affects coping
with physical impairments and Models of Health Promotion
independence
 A satisfactory level of social function is a  ONPRIME Model – Acronym for
significant outcome in itself Organizing
 Relationship between older adult and family play Needs resources assessment
a central role Priority setting
Research
HEALTH PROMOTION Intervention
Monitoring
Essentials of Health Promotion for Aging Adults Evaluation
 The purpose of health promotion and disease  An instructional model aimed at change
prevention is to reduce the potential years of life lost technology within health promotion programs.
in premature mortality and ensure a higher quality of
remaining life.  Health Belief Model – has 3 basic components:
1. the individual’s perception of his or her
 Health promotion and disease prevention activities susceptibility to and the severity of an illness or
included primary prevention, or the prevention of disease
disease before it occurs, and secondary prevention 2. modifying factors such as knowledge of the
which is the detection of disease at an early stage. disease, various personal psychosocial and
demographic variables, and cues or triggers to
 Variables affecting older adults’ participation in action
primary and secondary health promotion activities: 3. a cost/benefit ratio that is acceptable to the
1. Socioeconomic factors individual.
2. Belief and activities
3. Encouragement by Health Care Provider  PRECEDE/PROCEED Model – incorporates community
4. Specific motivation based on self-efficacy involvement in most aspects of its direction.
and outcome expectations  PRECEDE Phase (predisposing, reinforcing, and
5. Access to resources enabling constructs in education/environmental
diagnosis and evaluation.)
Terminologies  PROCEED Phase (policy, regulatory, and
 Health promotion – the science and art of helping organizational constructs in educational and
people change their lifestyle to move forward to state environmental development)
of optimum health.
 Optimum health - a balance of physical, emotional,
social, spiritual, and intellectual health.
 Health Promotion Model – presumes an active role  Benson’s Mind/Body Medical Institute
by the participant in developing and deciding the  Mind/body medicine
context in which health behaviors will be modified.  For individuals feeling the negative effects of
stress
Three categories:  Eliciting relaxation response
1. Older adults characteristics and life
experiences  Strong for Life
2. Their perceived decision making (self-  Exercise program for the disabled and
efficacy) nondisabled older adults.
3. The effect of the plan of action.  Exercise video, trainer’s manual, and a user’s
guide
Other Health Promotion Models
 Healthwise – handbook 190 common health problems
 Located at Boise, Idaho Barriers to Health Promotion and Disease Prevention
 Adopted by different states in the US and also in
other countries. Health Care Professionals’ Barriers to Health Promotion
 Physician approved guidelines on when to call a 1. Lack of clear and consistent guidelines.
health professional 2. Beliefs and attitudes of HCPs
 There was a decrease by 18% on visits to the 3. Lack of an organized system to facilitate the
emergency rooms delivery of screening services
 Nurse call center
Older Adults’ Barriers to Health Promotion
 Chronic Disease Self-Management Program 1. Socioeconomic factors
 Started by Kate Lorig, a nurse-researcher 2. Beliefs and attitude of patients and HCPs
 Done in groups of 12; led by peer leaders 3. Encouragement of HCP
 Peer leaders are also suffering from chronic 4. Specific motivation
diseases 5. Access to resources
 6 weeks; 2 ½ hours/week 6. Age, Gender and Status
 Uses techniques such as mastery of skills, peer 7. Lack of Transportation
modeling, social persuasion, etc. 8. Financial Limitations
9. Ethnic and cultural factors
 Project Enhance – partnership among university, an
area agency on aging, local and national foundations, Health Protection
health dept., senior centers, primary care providers,  Classification of Healthy People Initiative 2010
older volunteers and older participants.
Two components:  Healthy People Initiatives – objectives for the nation
1. Enhance fitness – exercise; stretching, flexibility, to achieve over the following 10 years.
balance, low impact aerobics, and strength  Healthy People 1990 – in 1980 known as
training Promoting Health/Preventing disease: objectives
 Last for an hour; 10 to 25 people for the nation. 226 objectives
2. Enhance wellness – mental health; depression  Healthy People 2000 – in 1990, effort to reduce
and mood problems, self-reliance and preventable death and disability for Americans.
decreasing need for drugs.  Healthy People 2010 – objectives increase to 467

 Ornish Program for Reversing heart disease Benefits

 Vegetarian diet  Gave recognition to health promotion rather than
 Moderate aerobic exercise focusing intensively on wars on diseases.
 Meditation  Documenting baselines, setting objectives and
 Group support sessions monitoring progress.
 Smoking cessation
Problems:
 Too much focus on monitoring
 Small publicity
  Very little financial support 2. Studying facts and the opinion of leaders on all sides
 As evidenced by steady increase in obesity and of an issue
sedentary lifestyle 3. Speaking to civic groups, political party groups, and
senior citizen groups
Disease Prevention 4. Testifying before the legislature as an advocate for
Primary Preventive Measures healthy aging
 Immunization – annual influenza vaccine, regular 5. Being informed on the issues and knowing social and
tetanus vaccination every 10 years. Pneumococcal political hot buttons
vaccination at 65th birthday with booster after 6 6. Putting the best foot forward with lobbying
years. 7. Studying issues and techniques of negotiation and
 Smoking and Alcohol Cessation – increases life compromise
expectancy and improve quality of life. Prevents 8. Actively supporting the role of the advanced practice
occurrence of falls and motor vehicle accidents. nurse working with PHCPs
 Polypharmacy – defined as the used of large
quantities of different drugs to relieve symptoms of Assessment
health deviation or symptoms resulting from drug  Self-perception/self-concept pattern
therapy.  Roles/Relationships pattern
 Health perception/health management patterns
Secondary Preventive Measures  Nutritional/metabolic pattern
 Consist of screening recommendations  Coping/Stress-tolerance pattern
 Value/belief pattern
PREVENTIVE SCREENING RECOMMENDATIONS  Activity/exercise pattern
TEST FREQUENCY  Rest/sleep pattern
Blood Pressure Annually  Sexuality/reproductive pattern
Hearing Annually  Elimination pattern
Vision Annually Planning
Glaucoma Annually Interventions to Motivate Individuals to Change Behavior
Mammogram Annually Factors Intervention
Dental or Oral Examination Annually Efficacy 1. Use verbal encouragement of capability
Pap Smear Annually Beliefs to perform.
Clinical Breast Examination Annually 2. Expose older adults to role models
Prostate Examination Annually (similar other who successfully perform
Cholesterol Screening As clinically indicated the activity.)
3. Decrease unpleasant sensations
PSA As clinically indicated
associated with the activity.
Guaiac Test As clinically indicated
4. Encourage actual performance/practice
Thyroid Function Test As clinically indicated
of the activity.
Blood/ Urine Sugar As clinically indicated
Unpleasant 1. Facilitate appropriate use of pain
physical medications to relive discomfort.
Tertiary Preventive Measures
sensations 2. Use alternative measures such as heat
(pain, fear) or ice to relive pain associated with the
The Nurse’s Role in Health Promotion and Disease
activity.
Prevention
3. Use cognitive therapy.
Requisite Knowledge
Individualized 1. Demonstrate kindness and caring to
 Knowledge of local, regional and national levels
Care patient
of action
2. Use humor
 Local - Case finding
3. Use positive reinforcement after a
 Regional – coordinating with state/provincial
desire behavior
departments
4. Recognize individual needs and
 National – education involving public policy.
differences such as providing a rest period
or favorite snack.
Spirituality 1. Explore the influences of spirituality
1. Becoming aware of current and changing social policy
 and traditional religion and as appropriate
encourage patient to participate in this.
2. Physically be with the older adult and
listen.
3. use life review
4. Encourage spiritual experiences: pets,
children, journals, prayer.

Social 1. evaluate the presence and adequacy of

support social network
2. Teach significant other to verbally
encourage or reinforce desired behavior
3. Use social supports as a source of goal
identification

Goal 1. Develop appropriate, realistic goals

identification with older adults.
2. Set goals that can be met in a short
time frame- daily or weekly
3. Set goals that are challenging but
attainable
4. Set goals that clear and specific.

Planning – self efficacy theory – the stronger the

individual’s belief that he or she can perform the behavior
and the stronger the individual’s belief that he or she can
perform the behavior.

Implementation – proactive

Supporting Geriatric Empowerment

 Active participation of nurses

 Learning about community resources and national
programs for health promotion
 Individualized approach