NCM 114

Nursing Care of the Older Adult in Wellness

• ASSESSMENT of an ELDERLY CLIENT
• Assessment of health and functioning of older adults is an essential and complex component of
nursing care .

How?
 Must possess necessary knowledge and skill
 Must know how to use diagnostic tools and equipment safely
 Must be knowledgeable and sensitive to the unique needs of older adults.
 Comprehensive assessment- is the basis of an individualized care for an older adult.
 Should be with enhanced skills in doing assessment to improve health outcomes,
increase confidence and provide role model for health care team(as a nurse)
 Systematic and integrated
 Lengthy

Comprehensive Assessment of Older Adults

• Major Components:
– PHYSICAL
– FUNCTIONAL
– COGNITIVE
– PSYCHOLOGICAL
– SOCIAL AND SPIRITUAL
• Sources of data:
– Primary – Patient/client
• Subjective – clients own personal description of their health status;
major essential in history taking
• Objective – observations / measurement of clients health status
– Secondary – family members, health professionals, records & reports,
laboratory/diagnostics analyses

HEALTH SCREENING
 To identify older individuals who are in need of further, more in-depth assessment
 Screenings are not designed to provide treatment
 Intended to identify significant findings

Screening Recommendations for Older Adults
Screening Test Recommendation
Screening for Colorectal

Cancer and Polyps One of the following after age 50:

 Yearly fecal occult blood testing (USPSTF)
 Flexible sigmoidoscopy every 5 years (USPSTF, ACS) + fecal
occult blood testing every 3 years (USPSTF)
 Colonoscopy every 10 years (USPSTF, ACS)
 Double-contrast barium enema every 5 years (ACS)
 CT colonography (virtual colonoscopy) every 5 years (ACS)

 Prostate Examination Consultation with primary care provider to discuss

appropriateness of screening at age 50, or at age 45 if
African American OR family history of prostate cancer
(ACS) Not recommended (USPSTF)
 Screening for Obesity At regular intervals (USPSTF)
 Bone Mineral Density Recommended for women age 65 or older
(USPSTF, NOF, ACOG) and men over age 70
(NOF)
 Hearing Screening Test Every 10 years (ASHA)
 Comprehensive Eye Examination Every 1 to 2 years; yearly if person has
diabetes (AAO)
 Abdominal Ultrasound Once between ages 65 and 75 in men who have
Aortic Aneurysm) ever smoked (USPSTF)

 Hepatitis C Screening Recommended for people at high risk of infection

(any history of injection drug use); one-time
screening recommended for all persons born
between 1945 and 1965 (USPSTF)

 Human Immunodeficiency Recommended for people at increased Virus

(HIV) Blood Test (USPSTF)

Type 2 Diabetes Screening Recommended every 3 years for people with

sustained BP of >135/80 mmHg (USPSTF), adults
who are overweight, or those with other risk factors
such as high cholesterol, family history, high risk
race/ethnicity, and physical inactivity (ADA)

American Academy of Ophthalmology(AAO)

American Congress of Obstetricians and Gynecologists (ACOG)
American Cancer Society (ACS)
American Diabetes Association (ADA)
American Speech-Language-Hearing Association(ASHA)
United States Preventive Services Task Force (USPSTF)
National Osteoporosis Foundation (NOF)
National Cholesterol Education Program(NCEP)

HEALTH ASSESSMENT
 It includes the collection of all types of important health-related data using a
variety of techniques.
 The information is used to identify patient problems and to plan patient care.
 Accurate and complete data should be collected.
 Data can be either
 SUBJECTIVE DATA
 OBJECTIVE DATE

Subjective Data
 Information gathered from the older person’s point of view.
 Best described in the individual’s own words.
examples of Subjectivedata:
 Fear
 Anxiety
 Frustration
 pain

Objective Data
 Information gathered using the different senses
 Collected by direct observation, and laboratory or diagnostic tests.
 Precise and specific (meters, monitors, and other measuring device.

INTERVIEWING OLDER ADULT

 Interviews conducted during admission to a facility usually are planned and
conducted in a formal manner.
 Other interviews may be spontaneous, informal, and based on an immediate
need recognized by the interviewer.

Preparing the Physical Setting

 Choose the interview environment carefully
– Minimize distractions:
 Noise from television
 Radios
  Phones
– Lighting should be diffused
– Furniture should be comfortable
– Privacy is very important

Establishing Rapport
 Greet the patient
 Introduce yourself
 If first contact, address the person using their formal names(e.g. Mr. Cruz, Mrs.
Dela paz)
 Briefly explain the purpose of the interview
 Explain how long you expect the interview to last.
 What will happen after it is completed
 Focus on and speak directly to the OP being interviewed
 Enhance rapport by determining the problems or concerns that most trouble the client
and then focusing on those problems
 Begin assessment with a look at the person as whole before focusing on specifics.

Structuring the Interview

• Plan sufficient time for the interview
• Try not to accomplish too much during a single interview
– It is better to have several brief interactions lasting > 30 mins each.
– Note for signs of fatigue, indicates the need to end the interview.
(sagging head/shoulders, sighing, altered facial expression and irritability)
– For accurate understanding of information ensure the used of
communication techniques
– Avoid using medical jargon
– Speak slowly and clearly and keeping messages simple
– Remain calm and emphatic
– Do not complete sentences for the OP
• The interview should not end abruptly
– Set time for further interaction
– Follow through is essential.

NURSING HISTORY
OBTAINING HEALTH HISTORY
• Before starting a physical assessment, the nurse will use interviewing techniques
to obtain a health history.
• History should include, but not limited to:
  Identifying data
 Past history
 Present medical history/Current history
 Family and psychosocial history

Guidelines for obtaining health History

General instructions:
• General requests for information may prompt a discussion of health information.
Making some or all of the following questions unnecessary.
• Social, cultural, developmental, educational levels are assessed throughout the
interview
• During the interview note the individual’s openness and readiness to learn
• Patience and good communication skills are essential
• Treat the patient with respect
• Face the OP and speak in a normal tone

HEALTH HISTORY DATA

IDENTIFYING DATA (Profiling)
• Name
• Date of birth
• Residence
• Ethnicity and cultural preferences
• Language preferences
• Religion
• Gender identity/preferred pronouns
• Marital/significant other status
• Previous and/or current occupation
• Educational background
• Advance directives and any other relevant data

PAST HISTORY
• Perception of general health
• Frequency of medical and dental care, including screenings, such as
mammography, BP
• Known or suspected allergies (medicines, food, animals etc).
 • History of serious illnesses (specify illness, date of onset, type of treatment
received, resolved vs. ongoing problem)
• Hospitalization (reason/date)
• Surgeries (type and date)
• Mental health treatment(type and date)
• Review of personal health habits, such as diet, fluid intake, exercise practices, sleep
patterns, bowel and bladder routines, alcohol, caffeine and tobacco use, sexual activity,
etc.
• Suggested opening statement: “It would help in
• planning your care if you tell me about your past
• health.”
• Were you immunized, (given shots or vaccinated) for any disease?
• Have you had a tetanus vaccination?
• What childhood disease did you have? Examples are measles and chickenpox.
• As an adult, what illnesses have you had that came and went, such as pneumonia or blood
clots?
• Were you ever treated for any mental problems, such as depression?
• What surgeries have you had?
• Did you ever injure yourself and then receive treatment? Do you ever fall?
• Were you ever in the hospital for any reason?
• Have you ever had an allergic reaction to medicine, such as penicillin? Do you have any
other allergies?

PRESENT MEDICAL HISTORY

• Major current problems or concerns (in person’s own words)
• Do the problems relate to an accident or fall?
• Symptoms (location, duration, severity, etc
• Date of onset (sudden or gradual onset)
• What makes problem worst or better
• What was done in response to symptom(s)(home remedies, visit to primary care
provider, etc.)
• Medications currently taken(look at bottles if possible)
• Adherence to medication regimen
• Current medical treatments or therapies(oxygen, physical therapies, etc.)

Suggested opening statement “ please tell me about your current health.”

• How would you describe your general health?
• Do you have any chronic problems, such as diabetes, high blood pressure, arthritis, or
heart disease?
• Have you had any weight loss or gain within last year? Within the last several weeks?
• Do you have any pain, unusual sensations, or lack of sensation
• Do you have any cough, shortness of breath, other trouble breathing? Do you cough up
any sputum? If yes, describe the sputum.
• Do you have any headaches, dizziness, weakness, fainting spells, or excessive sweating?
 • Do you have any swelling?
• Are there any discharges or drainage from anywhere?
• Does your heart ever race, pound, skip a beat, or have any other unusual sensations?
• Tell me all the medications you take, including prescription, over-the-counter, or home
remedy

Suggested opening statement: “Please tell me about your general

health habits.”
 Are you on a special diet? What food do you normally eat?
 Do you have any problem eating, such as trouble swallowing or have nausea or
vomiting after eating?

Suggested opening statement:

 Do you drink caffeinated beverages such as coffee, tea, or carbonated drinks?
 How many glasses of water do you drink in 1 day?
 How many hours do you usually sleep at night?
 Do you take naps? Do you have any problems sleeping? What type of sleeping
problems?
 What are your bowel habits? Do you use laxatives, suppositories, or enemas? Do you
ever have diarrhea?
 Tell me about your bladder habits. Do you urinate often during the day? How much do
you urinate? Small amounts or fairly large amounts? Do you have any problems
urinating? Do you get up at night to go to the bathroom?
 What type of exercise do you engage in? how often do you exercise? Do you drink any
alcoholic beverages? If so, what kind and how often?
 Do you smoke? If so, what and how often?
 Do you wear glasses, a hearing aid, or dentures? Describe hearing loss and any vision
loss.
 Do you use a cane, crutches or walker?
 Tell me about your memory.
FAMILY AND PSYCHOSOCIAL HISTORY
 Living family members(spouse, children, siblings, etc.) and nature of
relationships
 Friends and social activity practices(clubs, church activities,
community/organizations, online interactions, etc)
 Significant deceased family members
 Hobbies and interests
 Pets

NURSING FOCUS
Suggested opening statement: “Please tell me about your needs.”
 What are your strengths? Your weaknesses?
 What concerns do you have?
 What questions can I answer for you?
 What kind of help do you need?
 What could the nursing staff do to be the most helpful to you?

FUNCTIONAL HEALTH PATTERNS

• Clients’ functional health patterns (individuals, families, or communities)
evolve from client-environment interaction.
• Each pattern is an expression of biopsychosocial integration; thus not a
single pattern can be understood without knowledge of the other patterns.
• Functional patterns are influenced by biological, developmental, cultural,
social, and spiritual factors.
• A functional pattern represents a healthy set of behaviors.
• Dysfunctional health patterns (described by nursing diagnoses) may occur
with disease or lead to disease
• The judgment of whether a pattern is functional or dysfunctional is made by comparing
assessment data to one or more of the following:
• INDIVIDUAL BASELINES
• ESTABLISHED NORMS FOR AGE GROUPS
• CULTURAL, SOCIAL, OR OTHER NORMS

• Gordon identified 11 functional health patterns that are relevant

across the lifespan.
• Gordon’s model is a particularly useful tool to assess the health
status of an older person, (compared to normal developmental
patterns), develop appropriate healthcare intervention, and
evaluate outcomes of the care plan.
 1. Health perception/health management
– Regardless of age, motivation is an important factor in health
promotion and illness prevention.
– For an older adult, the motivation to engage in such behaviors
becomes even more critical to maintain an active and quality life.
– Nursing assessment criteria focusing on health perception and health management
includes:
1. adherence with recommended medication regime,
2. engaging in health promotion activities such as routine exercise/activities,
3. adhering to CDC recommended immunizations, screenings, and medical
visits.
2. Nutrition-metabolic
– Adequate and appropriate nutrition is critical at every age, with nutritional needs
changing over one’s lifespan.
– Nutrition is important to manage gastrointestinal disorders, wound healing and
skin integrity, energy levels, and overall health status.
– Obesity is pervasive among the older adult population, particularly among
women, and is a risk factor for developing chronic health problems including
cardiovascular diseases, diabetes, some cancers, and hypertension.
- Anorexia is another concern that is seen in the older adult.
• Common contributing factors to anorexia or lack of
appetite in older adults include medication side effects,
oral conditions, ill-fitting dentures, cultural factors, and
progression of a chronic disease.
• Dehydration often is a side effect of medications, along
with impaired or decline of taste receptors in the mouth
and tongue.
– Nursing assessment criteria focusing on nutrition and metabolic status in older
adults include:
• examining
• examining the teeth, mucus membrane, and oral cavity (fit of dentures);
and, the ability to chew and swallow food.
• Another important consideration is the individual’s access to a well-
balanced diet (resources to purchase food, food preparation, etc.).
• It is important to routinely weigh older adults to assess for changes that
could reflect nutrition-metabolic conditions.

3. Elimination
– Associated with the normal aging process in older adults are
changes in bowel and bladder functions.
– Bladder capacity decreases, resulting in more trips to the bathroom
and, in many instances, disrupted sleep patterns.
– Frequency is especially common in males associated with benign prostatic
hypertrophy (BPH).
 – Urinary incontinence and “dribbling” (stress incontinence) are often reported by
older women.
 Changes in genitourinary patterns can lead to incontinence,
infections and skin breakdown, and even social isolation
– Medication side effects can exacerbate elimination problems such as opiates and
diuretics.

– Common complaints by older adults include irregularity, persistent or acute abdominal

cramping, excessive straining with incomplete evacuation, and blood in the stool.

– Elimination symptoms often lead to the use and increased reliance on laxatives or
enemas, which can exacerbate gastrointestinal disorders.

– Nursing assessment criteria focusing on elimination include:

• frequency of bowel movement,

• voiding pattern,

• pain with urination, and the appearance of urine and stool. If constipation is a
problem, inquire how the individual manages this condition (e.g., intake of high
fiber foods, laxatives, suppositories, enema, etc.).

• Activity–exercise

– Healthy People 2020 national objectives include a specific goal focusing on the

increasing percentage of adults who exercise on a regular basis.

– Regular physical activity is critical for preventing and managing chronic health problems
such as obesity, diabetes, depression, and musculoskeletal conditions. Physical activity
generally decreases associated with aging processes.

– A combination of muscle strengthening activities along with aerobic and anaerobic

exercises are important to maintain balance and musculoskeletal integrity.

– Popular activities for older adults should include muscle and strength-building along
with weight-bearing exercises.

– Before beginning any exercise program, the older adult should first consult with a
medical practitioner.

– Nursing assessment criteria focusing on activity/exercise include:

– assessing cardiovascular and respiratory status,

– assessing mobility and balance,

and inquiring about activities of daily living and whether this includes physical activities.

5. Cognitive-perceptual
 - Cognition (i.e., thinking processes) has been of interest to researchers over the
past decade in response to the growing prevalence of various types of dementia in
older adults.
- Numerous theories are offered as to the physiological changes in the human brain
during the aging process.
- However, no consensus of evidence exists as to why some centenarians
experience cognitive decline while others remain mentally sharp.
– Factors that contribute to cognition status associated with aging include
cultural patterns, level of formal education, heredity, lifestyle behaviors,
medication side effects, nutrition, environmental exposures, and
occupational exposures, among others.
– Nursing assessment criteria focusing on cognitive perceptual patterns in older
adults include:
 appraisal of vision, hearing, taste, touch, smell, pain perception,
and lifestyle behaviors.
 Mental health assessment should address orientation to person,
time, and place.
 Other components of cognitive functions include language skills,
memory/recall, and decision-making.
– Nursing assessment criteria focusing on cognitive perceptual patterns in older
adults include:
 Common symptoms of dementia include short-term memory loss,
disorganized thinking, perceptual disturbances, sleep wake
disorders, psychomotor challenges, and disorientation.
 One must be cautious when assessing an older adult who presents
with confusion or reported cognitive impairment.
 Confusion may not be indicative of dementia, but could be
associated with health problems such as diabetes and Parkinson’s
disease, hypoxia, electrolyte imbalance, hearing or vision loss,
medication side effects, and depression.

6. Sleep-rest
- Disruption in sleep and insomnia are commonly reported problems by older
adults.
- Sleep disorders include insomnia, sleep apnea, waking up early with an inability
to go back to sleep, and fatigue upon awakening.
- Concomitantly, other subjective reported symptoms include excessive sleepiness
during the day and falling asleep at inopportune times.
- Consequently, the older adult may resort to medications such as benzodiazepines
or barbiturates, which can lead to dependence, falls/fall-related injuries, metabolic
disorders (e.g., constipation, anorexia, hypoxia), and impaired cognition.

- Nursing assessment criteria should focus on sleep/rest patterns in older adults and
their perceived (subjective) sleep experiences.
  Include questions focusing on sleep pattern during the night,
napping during the day, urinary frequency, and sleep hygiene (i.e.
bedtime routines, sleep aids, etc.).
 If possible, ask the individual older adult to keep a written journal
of sleep patterns over a 24-hour period for several weeks.

7. Self-perception/self-concept
- Erik Erikson’s theory focusing on stages of psychosocial development specifies
“generativity versus stagnation” for middle adulthood (40 years to 65 years); and
“ego integrity versus despair” as the developmental task associated with maturity
(65+ years).
- Depending on one’s biological age someone in either of these two groups could
be classified as “older adult” .
- During middle adulthood, major life changes occur as the individual attempts to
redefine his or her life purpose associated with children leaving the home along
with career and relationship changes. Erikson’s maturity stage entails achieving
an identity apart from work roles, adjusting to normal aging changes, and
accepting the inevitability of losses and death.
- Nursing assessment criteria focusing on self-perception/self-concept should
include:
 open-ended questions related to the individual’s comfort with their
body image in light of the physiological changes associated with
aging, such as self-perception of one’s abilities along with major
life role changes.
 Objective assessment data would include body posture, eye
contact, voice tone, and activities of daily living.

Erik Erikson's Stages of Psychosocial Development

• Erik Erikson maintained that personality develops in a predetermined order

through eight stages of psychosocial development, from infancy to
adulthood. During each stage, the person experiences a psychosocial crisis
which could have a positive or negative outcome for personality
development.
• For Erikson (1958, 1963), these crises are of a psychosocial nature because
they involve psychological needs of the individual (i.e., psycho) conflicting
with the needs of society (i.e., social).
• According to the theory, successful completion of each stage results in a healthy
personality and the acquisition of basic virtues. Basic virtues are characteristic strengths
which the ego can use to resolve subsequent crises.
 • Failure to successfully complete a stage can result in a reduced ability to complete further
stages and therefore a more unhealthy personality and sense of self.  These stages,
however, can be resolved successfully at a later time.
Generativity vs. Stagnation
– Psychologically, generativity refers to "making your mark" on the world through
creating or nurturing things that will outlast an individual.
– During middle age, individuals experience a need to create or nurture things that
will outlast them, often having mentees or creating positive changes that will
benefit other people.
– Success leads to feelings of usefulness and accomplishment, and having the virtue
of CARE
– By failing to find a way to contribute, they become stagnant and feel
unproductive. These individuals may feel disconnected or uninvolved with their
community and with society as a whole. Which results in shallow involvement in
the world.

Ego Integrity vs. Despair

– Individuals who reflect on their life and regret not achieving their goals will
experience feelings of bitterness and despair.
– Erikson described ego integrity as “the acceptance of one’s one and only life cycle
as something that had to be” (1950, p. 268) and later as “a sense of coherence and
wholeness” (1982, p. 65).
– As we grow older (65+ yrs) and become senior citizens, we tend to slow down our
productivity and explore life as a retired person.
– Erik Erikson believed if we see our lives as unproductive, feel guilt about our
past, or feel that we did not accomplish our life goals, we become dissatisfied
with life and develop despair, often leading to depression and hopelessness
– Success in this stage will lead to the virtue of wisdom. Wisdom enables a person
to look back on their life with a sense of closure and completeness, and also
accept death without fear.
– Wise people are not characterized by a continuous state of ego integrity, but they
experience both ego integrity and despair. Thus, late life is characterized by both
integrity and despair as alternating states that need to be balanced.
–

8. Role-relationship
- Associated with Erikson development tasks are one’s roles, responsibilities, and
relationship changes across the lifespan.
- Roles such as parenting, or being a child, sibling, or spouse will change in the
event of a child leaving the home, illness, debilitating injury, or death.
- The manner in which the older adult adapts to these changes contributes to
lifestyle behaviors, socialization, and ultimately health status.
 - Nursing assessment criteria focusing on role-relationships in the older adult
should include:
 a review of perceived roles and responsibilities, and perceived
quality of life related to these changing dynamics.
 Ultimately, health care providers should assess current and
potential changes and offer appropriate anticipatory guidance to
help the older adult adapt to developmental and situational life
events and changes.

9. Sexuality-reproductive
– The Centers For Disease Control indicates that sexual health is a state of
physical, emotional, mental, and social well-being in relation to sexuality; it
is not merely the absence of disease, dysfunction, or infirmity
(https://www.cdc.gov/sexualhealth).
– Sexual health requires positive and respectful approach to sexuality and
intimate relationships as well as the possibility of having pleasurable and
safe sexual experiences.
– Older adults continue to have the human need for intimacy, love, and
touch, an integral dimension of human sexuality.
– Physiological and emotional factors, along with health status and
medication, can impact an older adult’s intimacy and sexuality
experiences.
– Nursing assessment criteria focusing on sexual/reproductive pattern in older
adults include:
 history and satisfaction with pregnancies/childbirth, satisfaction
with sexual relationship, and sexual functioning.
 Nurses are in an ideal position to help older adults understand
changes in sexuality associated with aging processes.
 It is essential that the nurses be educated, informed, and confident
to discuss this important but highly sensitive issue with older
adults.

10. Coping/stress tolerance

- A critical component of human development relates to one’s ability to effectively
cope with life’s stresses, which, in turn, influence self-concept.
- As individuals age they encounter numerous losses (spouse, friends, siblings,
children, employment, income, etc.).
- Living arrangements also can contribute to loss experiences, such as downsizing
from the established family home and moving to a smaller living situation (e.g.,
apartment or progressive care facility such as independent living, assisted living,
and long-term care).
- There may be a decline in income, physical functioning, and health status.
Multiple changes often are overwhelming for the older adult as well as for family
members. An individual who had productive coping patterns early on in life may
 be overwhelmed with the stressors that occur with aging and no longer able to
adhere to reliable coping patterns.
– Older adults may be depressed, which can manifest in symptoms and
behaviors that may be reported as confusion, dementia, or cognitive
impairment.
– Medication side effects may exacerbate mood disorders and further
interfere with former coping behaviors.
– Self-medicating and alcohol use may come to be relied upon as the
preferred coping strategy.
– Depression, too, remains undiagnosed or misdiagnosed and misconstrued
as impaired cognition. These coping behaviors increase the risk for falls
and other types of trauma-inducing events.
– It is important to note that suicide rates remain high among older adults
and the potential should always be included in the assessment.
- Nursing assessment criteria focusing on coping/stress tolerance in the older adult
should include:
- the individual’s historical approaches to deal with stress, access to available
support systems, and perceived ability to control or manage stressful life
situations.
- Screen for depression, substance use/abuse, and risk for self-harm.

11. Values-beliefs
- Belief systems and values develop early in life but are modified with life
experiences.
- Spirituality often establishes an underlying guide to an older adult’s belief
systems and corresponding behaviors.
- ‘Spirituality’ is highly personal and differs somewhat from the concept of
‘religiosity’.
- Spirituality influences a person’s values– beliefs about life, aging, illness, and
death. When addressing spirituality, the nurse must be non-judgmental, highly
sensitive, and unobtrusive when inquiring about the older adult’s values and
beliefs.
- Nursing assessment criteria focusing on values/beliefs include:
 inquiring about religious affiliation and what the older adult
perceives as important in life;
 if there are values/beliefs that conflict with their religious
affiliation; and special religious practices and rituals.
Gordon’s Functional Patterns,
Description, and Assessment
Exemplars
 FUNCTIONAL ASSESSMENT
 Nurses typically conduct a functional assessment in order to identify an older
adult’s ability to perform self-care, self-maintenance, and physical activities,
and plan appropriate nursing interventions
 TWO APPROACHES:
1. To ask questions about ability (verbal tools)
2. To observe ability through evaluating task completion( observational tools)

• Completing brief assessment of older patients requires effective use of a broad

range medical interviewing skills. Application of a few simple interviewing
techniques will substantially enhance the amount and accuracy of information
obtained in speaking with older patients.

 Verbal and observational tools also used to screen for DISABILITY

 Disability refers to the impact that health problems have on an individual’s ability
to perform task, roles, and activities, and it is often measured by asking
questions about the Activities of Daily Living (ADL)
 • ADL can be stratified according to difficulty and complexity in three levels of
functioning
– Basic ADL (BADL)
– Instrumental ADL (IADL)
– Advanced ADL (AADL

Basic Activities of Daily Living – BADLs

• Defined as the activities meeting the basic physiological and self-
maintenance needs.
• The basic activities of daily living (ADLs) involve personal care.
• ADLs are the essential elements of self-care. Inability to independently perform
even one activity may indicate a need for supportive services.
• Example : KATZ Index of Independence in ADL, BARTHEL INDEX
Instrumental Activities of Daily Living – IADLs
• IADLs are associated with independent living in the community and provide a
basis for considering the type of services necessary in maintaining
independence.
• The IADL screening instrument can uncover more subtle disabilities.
• Example : Lawton-Brody IADL Scale; late Life Function & Disability Instrument
( Function/ Disability component); SF-36; FSQ
Advanced ADL (AADLs)
• These are more sophisticated activities, beyond those necessary to live
independently.
• Important to maintain their self identity
• Example:
– COPM (Canadian Occupational performance Measure) a combined
elements of ADLs IADLs and AADLs.
• Assesses an individual's perceived occupational performance in the
areas of self-care, productivity, and leisure
• Is a tool allowing the evaluation of subtle functional decline in mild cognitive
impairment

• Can be used to establish the diagnosis of AD (Alzheimer’s disease) in an earlier stage ➙

these are activities that demand high cognitive functioning and are more responsive to
subtle changes.
• The AADL tool is based on the total number of activities performed (TNA) by
a person and takes each subject as his own reference.
– Total Disability Index (AADL-DI)
– Cognitive Disability Index (AADL-CDI)
– Physical Disability Index (AADL-PDI
• The AADL-CDI and AADL-DI is useful in identifying mild cognitive disorder in
older adults.
• fecal occult

testing
(USPST
• Flexibl
sigmoid
every 5
(USPST
ACS) +
occult b
testing
years
(USPST
• Colono
every 1
(USPST
ACS)
• Double
contras
enema
years (A
• CT
colonog
(virtual
colonos
every 5
(ACS)