ASSESSMENT:

Focus on Function
WEEK 2
JANUARY 24, 2019

Mark Ebony C. Sumalinog, RN, MSN

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BACKGROUND:
• Hallmark of gerontological care
• Functional decline as a common pathway in aging
• Key constructs of functional health:
• ADLs
• IADLs
• Psychological
• Social
• Research: prevention and treatment of functional decline (frailty),
rehabilitation, and prevention of disability
• Assessment focuse on function -> Improved Care of Older Adults
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DEFINITION:
• FUNCTIONAL STATUS: person's ability to perform activities necessary
to ensure well-being
• Systems model
BIOLO
GICAL
PSYCHOL
OGICAL
SOCIAL

ENVIRONMENT
FUNCTION
INTERACT
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 • Each domain provides a critical component of the person's overall
health, need for care, and prognosis

OVERALL
HEALTH AND
WELL-BEING
ADAPTIVE
RESPONSE
3
DOMAINS
STRESSORS

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 Therefore,
broadening traditional assessment
to include all three domains gives a
comprehensive picture of the adaptation
of the older adult.

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 SOCIAL
ECONOMIC
ENVIRON FU
MENT NC
EN TI
D ON
U R AL
E B ST
EAS AT
US
D IS
I C I M
O N PA
R I RM
C H
EN
T
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• The interrelationship of the biopsychosocial domains are
mediated by chronic disease burden and functional status
impairment.

• QoL is influenced by each of these factors when deficits exist.

• As chronic disease burden increases, the risk for functional

impairment rises and QoL is threatened.

• With functional decline, the risk for increased healthcare

utilization, nursing home placement and death INCREASE.
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COMPREHENSIVE ASSESSMENT
• HOLISTIC- grounded in the wholeness of the individual

• provided for older adults with complex problems through geriatric

assessment programs that are MADE UP OF INTERDISCIPLINARY
TEAMS of geriatric professionals

nurse, nurse practitioner, physician, geriatrician, social worker,

psychologist, psychiatrist, pharmacist, occupational therapist,
physical therapist, chaplain, and dietitian

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• The roles of various professionals overlap and nurses should be able
to perform a comprehensive assessment of older adults that has a
focus on FUNCTION.

• Purpose of the assessment: identify patterns of functioning that

deviate from baseline or from accepted standards.

• Opportunity to IDENTIFY HEALTH PROMOTION AND DISEASE

PREVENTION ACTIVITIES that may enhance overall well-being.

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THE NURSING PROCESS:
Special considerations for the older adult

• KNOWLEDGE ON AGE RELATED CHANGES and the societal response

to the aging population LED TO THE MODIFICATIONS in generic
nursing approaches when working with older adults.

• OLDER ADULTS ARE A HETEROGENOUS GROUP

• INDIVIDUALIZED CARE SHOULD BE THE NORM

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Tailoring the nursing assessment
to the older person (tips)
• Provide adequate space, particularly if the patient uses mobility aid
• minimize the noise and distraction such as those generated by
television, radio, intercom, or or nearby activity
• set a comfortable, sufficiently warm temperature and ensure no
drafts are present
• use diffuse lighting with increased illuminations; avoid directional or
localized light
• avoid glossy or highly polished surfaces, including floors, walls,
ceilings and furnitures

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• Place the patient in a comfortable seating position that facilitates
information exchange
• ensure the older adult's proximity to a bathroom
• keep water or other preferred fluids available
• provide a place to hang or store garments and belongings
• maintain absolute privacy
• plan the assessment, taking into account the older person's energy
level, pace, and adaptibility.

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• More than one session may be necessary to complete assessment
• be patient, relaxed, and unhurried
• allow the patient plenty of time to respond to questions and
directions
• maximize the use of silence to allow the patient time to collect
thoughts before responding
• be alert to signs of increasing fatigue such as sighing, grimacing,
irritability, leaning against objects for support, dropping of the head
and shoulders, and progressive slowing

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• conduct the assessment during the patient's peak of energy time.
• measure the performance at under the most favorable condition
• take advantage of natural opportunities that would elicit asset and
capabilities; collect data during bathing, grooming, and mealtime
• ensure that assistive sensory devices (glasses, hearing aid) and
mobility devices (walker, cane, prosthesis) are in place and
functioning properly
• interview family, friends, and significant others who are involved in
patient's care to validate assessment data

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• Use body language, touch, eye contact, and speech to promote the
patient's maximum degree of participation
• be aware of the patient's emotional state and concerns, fear, anxiety,
and boredom may lead to inaccurate assessment conclusions
regarding functional ability

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 MODIFICATIONS
IN NURSING PROCESS WITH
OLDER ADULTS
(A-D-P-I-E)

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I. ASSESSMENT
• COMPLEX AND TIME CONSUMING PROCESS
• IMPOSSIBLE TO PERFORM IN JUST ONE ENCOUNTER
• THEY LOVE REMINISCING AND TALKING
• nurse may need to refocus the conversation in order to obtain necessary
information
• KNOWLEDGE ON AGE-RELATED CHANGES is ESSENTIAL
• ignorance may lead to misconception that common conditions and symptoms are
part of normal aging rather than a disease process
• results to underdiagnosis and undertreatment of the problem
• older adults may have this misconception too (atypical) -> they do not report
assuming they have to live with it
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HOW ILLNESS CHANGE WITH
AGE (example)
PROBLEM: Urinary Tract Infection (UTI)

• Young- dysuria, frequency, urgency

• Elderly- incontinence, confusion, anorexia, dysuria OFTEN ABSENT;

frequency, urgency, nocturia may be present

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HOW ILLNESS CHANGE WITH
AGE (example)
PROBLEM: Myocardial Infarction (MI)

• Young- severe substernal chest pain, diaphoresis, nausea, SOB

• Elderly- sometimes no chest pain or atypical pain location such as the

jaw, neck or shoulder; SOB, tachypnea, arrhythmia, hypotension,
restlessness, syncope and confusion

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ASSESSMENT UNIVE
RSAL
• Therefore, the nurse should
be able to distinguish
between normal aging and DETERIOR
pathologic aging IRREVER ATING/
SIBLE
Normal DELETERI
OOUS

PROGRE
SSIVE

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MODIFICATIONS NECESSARY BECAUSE OF
AGE-RELATED CHANGES AND HEALTH
CONDITIONS
• Slower pace of the nursing process

• Emphasis on functional abilities

• Attention to the effects of the aging process in disease presentation

and responses to disease and treatment

• Emphasis on nursing diagnosis and geriatric syndromes common to

older adults (dementia, incontinence, delirium, falls, etc…)
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MODIFICATIONS NECESSARY BECAUSE OF
AGE-RELATED CHANGES AND HEALTH
CONDITIONS
• Attention to the social, economic, and political influences on
healthcare for this age-group

• Increased alertness for signs of intensified stress state, and

iatrogenic responses to interventions

• Multi-dimensional effect of problems

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MODIFICATIONS NECESSARY BECAUSE OF
LOCATION OF CARE
• Financial resources available to implement a plan of cae

• Health care professionals available to implement a plan of care

• Priority setting (which health interventions to carry out)

• The older adult's goal

• Increased attention to environmental modifications as an intervention or as a

source of problems for older adults
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MODIFICATIONS NECESSARY BECAUSE OF
DEVELOPMENTAL LEVEL
• Goals and priority setting

• Attention to competency levels in those with cognitive impairment

• Awareness of losses and impact on the older adult

• Emphasis in coping and self-management of chronic diseases

• Increased attention to concerns about the dying process and end-of-life care

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BEFORE THE ASSESSMENT
• The nurse can begin the process of assessment and planning
• Review the older adult's medical chart (recommended)
because this will give direction for the assessment
 past medical, personal and social history; management plan for
current health problems; medications; immunization history;
laboratory results
 past health promotion activities: to identify if the goal has been
met
 from other healthcare providers who are familiar with the
person

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THE ASSESSMENT ENCOUNTER
10 KEY POINTS IN OLDER ADULTS ASSESSMENT-

1. Identify personal biases/ stereotypes about older adults so they can be

avoided

2. Be aware of age-related changes in each body system

3. Distinguish between normal and pathologic aging

4. Know the atypical presentation of illnesses

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THE ASSESSMENT ENCOUNTER
10 KEY POINTS IN OLDER ADULTS ASSESSMENT-

5. Allow time for trust to develop and to gather assessment information

6. Make accomodations for any impairments to promote comfort

7. Screen for conditions common in the older adults

8. Be alert to signs of elder abuse or neglect

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THE ASSESSMENT ENCOUNTER
10 KEY POINTS IN OLDER ADULTS ASSESSMENT-

9. Always consider medications and their effects as a cause /

contributor to a problem

10. Use collateral sources to validate the person's report

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THE DO'S OF GERIATRIC
ASSESSMENT
• Use your senses to evaluate the older person's to the questions
(mood, sensory function, comfort level, body integrity, grooming)

• modify the interaction style to accommodate sensory deficits (voice

modulation and attention to seating arrangement)

• provide support and instill confidence and trust

• provide reinforcements for positive health behaviors

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• Check for communication barriers (visual problems, hearing loss,
aphasia, impaired cognition)

• reduce white noise

• ensure a comfortable temperature, adequate space, lighting and privacy

• avoid glare from windows or shiny surfaces that can interfere with
vision

• eye-contact

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• face the person to allow lip reading

• make sure assistive devices (hearing aid and glasses) are on and in good
condition

• check for pain, thirst and the need to use the toilet

• relaxed pace

• silence- to collect ones thoughts in order to formulate an answer

• redirect the conversation if it is out of focus

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• assessment (for example mental testing) can produce anxiety:
introduce testing techniques as part of the normal examination/
conversation and explain how this will help in formulating
individualized care

• mutual expectations between the nurse and the older adult: foster
collaboration between the two, both will participate in decision
making and care; the older adult to be in control to the greatest
extent possible with the nurse serving as supportive role

• engage family and friends (to assist in assessment, whenever

possible) if the older adult can not articulate needs or concerns

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• Direct observation- most reliable data (getting dressed, drinking
fluids, eating a meal, ambulating, bathing, taking ones
medications)

• respect the elderly's good and bad days- eg. early morning knee
stiffness can negatively affect performance and person's usual
functioning., may not be cooperative

• confirm findings with a family member, caregiver, or other

health professionals
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 COMMON NURSING DIAGNOSIS FOR OLDER ADULTS
by HEALTH PATTERNS
Health Perception-Health Management Pattern:
• Altered Health Maintenance
• Risk for Injury: Falls
• Risk for Poisoning: Drug Toxicity
• Risk for Infection
• Impaired Home Maintenance
• Health seeking behavior
• Ineffective Management of Therapeutic Regimen
• Elder Mistreatment
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 COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS

Nutritional-Metabolic Pattern:
• Impaired Skin Integrity: Pressure Ulcer
• Impaired Skin Integrity: Dry Skin
• Alterned Nutrition: Less than body requirements
• Impaired swallowing
• Altered oral mucous membrane
• Fluid Volume Deficit: Dehydration
• Risk for Altered Body Temperature
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 COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS

Elimination Pattern:
• Constipation
• Diarrhea
• Bowel Incontinence
• Urinary Incontinence

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 COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS

Activity-Exercise Pattern:
• Decreased Cardiac Output
• Altered Tissue Perfusion
• Ineffective Breathing Pattern
• Activity Intolerance
• Impaired Physical Mobility
• Self-care Deficit
• Diversional Activity Deficit
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COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS
Sleep-Rest Pattern:
• Sleep Pattern Disturbance • Knowledge Deficit
• Cognitive Perceptual Pattern
• Chronic Confusion
• Acute Confusion
• Pain
• Sensory/Perceptual Alteration
• Unilateral Neglect

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COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS
Self-Perception - Self-Concept Role-Relationship Pattern:
Pattern: • Relocation Stress Syndrome
• Depression • Grieving
• Body Image Disturbance • Social Isolation
• Powerlessness • Impaired Communication
• Anxiety and Fear • Caregiver Role Strain
• Self-Esteem Disturbance • Risk for Violence: Directed at Self
• Hopelessness or Others
• Altered Family Processes
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COMMON NURSING DIAGNOSIS FOR OLDER
ADULTS by HEALTH PATTERNS
Sexuality-Reproductive Pattern: Coping Stress Tolerance Pattern:

• Sexual Dysfunction • Ineffective Coping

• Altered Sexuality Patterns

Value-Belief Pattern:
• Spiritual Distress

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PLANNING
TWO TYPES OF ENVIRONMENTAL INFLUENCES THAT THE NURSE
SHOULD TAKE INTO CONSIDERATION WHEN PLANNING CARE FOR AN
OLDER ADULT:
1. HEALTH CARE SYSTEM
2. SOCIAL SYSTEM

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PLANNING
1. HEALTH CARE SYSTEM
Nurse's goal: must be appropriate to the type of person seeking
care, given the options and resources.
eg. an older adult cared for by the Department of Veterans Affairs
may have resources that are not available to the indigent who seeks
help in a free clinic (poor vs rich)
Healthful Outcomes are POSSIBLE in both situations, but the
strategies are likely to be quite different.

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PLANNING
2. Social System
eg. Older adults from large, healthy families in which the long
standing cultural norm is to “take care of their own” may have a
wider range of options for assistance than individuals with limited
family or friends or limited finances.

affect judgement about what goals are attainable

affects how the nurse would shape his activities with that person
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PLANNING
• Involvement of family members in the planning of nursing care is
important because majority of the long-term care is provided at
home.

• determine the functional family unit especially those who needs long
term care

• consideration should be given to family members' goals and need

such as socialization and respite

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PLANNING
• Interdisciplinary team involvement- specialists from other fields

• Nurses should be knowledgeable about behaviours that facilitate

positive team interaction and be prepared to support the patient or
family member in establishing goals for healthcare

• Issues: teamwork, communication and collaboration

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PLANNING
• Identify desired outcomes related to the goals using the Nursing
Outcomes Classification (NOC)
• The NOC provides a standardized language that describes what the
patient is experiencing and the outcomes are developed in such a
way that changes can be measured.

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INTERVENTION
• May need to be modified to adapt to the special needs of older people

• The Nursing Interventions Classification (NIC) provides a broad

standardized list of interventions that make up the final step in
documentation of nursing actions.

• NIC interventions are described with a definition and a list of nursing

activities

• NIC provides a number of activities that may be appropriate

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INTERVENTION

NANDA
+
NIC
NCP
+
NOC
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INTERVENTION
INTERVENTIONS IS AFFECTED BY THE AGING PROCESS
• Some interventions are used more frequently
• Others are used less frequently
• Manner of implementation is modified

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INTERVENTION
• Interventions are used more frequently:

eg. increased need for services and the fragmented nature of

healthcare system for older adults requires nurses to be involved in
coordination of services more often than with younger adults.

Case management has has helped decrease care fragmentatation

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INTERVENTION
• Interventions may be used less

eg. dietary restrictions- 60s and 70s with cardiac problems and
high cholesterol may need to monitor their daily intake of saturated
fats.
80s and 90s are at risk for weight loss and poor nutritional intake.
They may continue to restrict their intake of this food group. HCP
must liberalize their diet especially that they are already frail.
More food choices and food that they will truly enjoy.

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INTERVENTION
• Manner of implementation is modified:

eg. health teaching- many health education materials like pamphlets are
developed with the younger adults in mind such as information on
exercise.

The picture shows young adults doing vigorous exercise. The print may be
small and colors used are not visually friendly to the elderly.

What to do? larger fonts, contrast colors, and age-appropriate

interventions
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EVALUATION
• Measured using the criteria set using NOC.

• Must document patient progress.

• Younger adults- focused on health promotion to improve health and

fitness.

• Older adults- maintain health and prevent decline

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EVALUATION
• Young adults- shorter period of time to improve one's health
conditions

• Older adults- time is extended especially those suffering from chronic

illnesses.

eg. 35 year old with hip fracture may regain independent

functional ability faster than an 80 year old with the same type of
fracture.

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 Comprehensive
Nursing Assessment:
Focus on Function

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Initial History
• Age • past medical, personal, social
• gender history
• occupation • lifestyle practices
• marital status • educational history, literacy and
health literacy
• current medication
• chief complaint
• food and drug allergies
• history of present illness
• complementary and alternative
medications • review of systems
• differential diagnosis
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Physical Examination
• Systematic • body build
• overall appearance • skin color
• physical function • personal hygiene
• sensory function • dress
• ability to communicate • posture
• general state of health • gait
• level of consciousness
• motor coordination
• facial expression
• body odor
• height and weight
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• altogether, the initial assessment and data collection is termed as the
GENERAL SURVEY

• KEY ISSUES should also be identified early in the encounter; the

assessment may be targeted in certain areas of concern, stemming
from the chief complaint.

• the introductory encounter provides cues to about potential sensory

and cognitive deficits, general health status, and concerns or
problems, social support, and expectations of care.
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GORDON'S 11 CATEGORIES OF
FUNCTIONAL PATTERNS
1. Health-Perception Health 6. Cognitive Perceptual Pattern
Management Pattern 7. Self-Perception Self-Concept
2. Nutritional Metabollic Pattern
Pattern 8. Role Relatioship Pattern
3. Elimination Pattern 9. Sexuality Reproductive
Pattern
4. Activity Exercise Pattern
10.Coping Stress Tolerance
5. Sleep Rest Pattern Pattern
11.Value Belief Pattern
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Health Perception Health
Management Pattern
• General: How would you describe your health?
• Health Maintenance and Promotion practices
• Current Health Problems and Management
• Medications
• Limitations
• Self-care
• Advanced Care Planning
• Laboratory Assessment: eg. HbA1c for the last 3 months

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Nutrition Metabollic Pattern
• General: How is your appetite? Has it recently changed?
• Dietary Habits: 24 hour recall
• Difficulty
• Weight
• Hydration
• Other factors influencing intake
• Nutritional supplements

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Nutrition Metabollic Pattern
• Physical Examination:
• General appearance, anthropometric measurement (BMI),
Hydration, mucous membranes, integumentary, cardiovascular (BP
and pulse), musculoskeletal (strength), and observation (observe
eating behavior)

• Laboratory
• CBC, serum albumin, cholesterol level - markers or poor nutritional
status
• TSH, Vit B12, folate and hepatic profile
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Elimination Pattern
URINARY
• General: Have you noticed any recent changes or problems with
urination?
• Hydration
• Urinary incontinence
• Urinary alterations: eg. indwelling catheter

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Elimination Pattern
• Physical Examination:
• Genitourinary assessment (inspect distended bladder, etc.)
• Men: enlarged prostate, rectal tone
• Women: discharges, vaginal and bladder prolapse (cystocele)
• incontinence
• Urinanry alterations

• Laboratory
• Urinalysis, renal function test (BUN), and Prostate Specific Antigen
(PSA)
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Elimination Pattern
BOWEL
• General: Has there been a recent change in bowel habits?
• Usual bowel function
• Bowel alterations: colostomy, ileostomy

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Elimination Pattern
• Physical Examination:
• Abdominal examination (IPAP)
• Rectal examination: hemorrhoids, fissures, sphincter tone, fecal
incontinence and impaction
• Bowel alterations: stoma of colostomy, describe stool
• Medication review: use of laxatives

• Laboratory:
• Guaiac testing: check for occult blood in stool for cancer, colonoscopy,
sigmoidoscopy, S/E-OPEH
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Activity Exercise Pattern
• General: How often do you • Cardiovascular/ Altered tissue
participate in regular physical perfusion
activity? • Respiratory
• Typical day • Musculoskeletal
• Physical activity • Falls
• Assessment of ADLs and IADLs • Social and recreational activities
• Limitations
• Driving assessment

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Activity Exercise Pattern
• Physical Examination • auscultate lungs and note for
• Vital signs (at rest, moderate and adventitious sounds; O2 sat
vigoruos) • ROM, tremor, spasm, and
• >20/10 mmhg in <3mins. = symmetry, pain, kyphosis and
orthostatic hypotension other spine misalignment
• allow person to lie for 10 minutes
before bp taking • Balance, coordination, gait
• recheck BP and HR after 3 mins of • ADLs/ IADLs
standing
• CRT, apical, radial and peripheral
pulse; and edema
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Activity Exercise Pattern
• Laboratory
• CBC for anemia
• O2 sat via pulse oximeter
• CXR and ECG-
• stress test
• bone density test

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Sleep Rest Pattern
• General: Do you typically feel rested after sleep?
• current patterns: difficulty sleeping, staying asleep, waking up to
early, nocturia, nightmares, fear of oversleep and quality of sleep
• changes- chronic illnesses
• sleep routines
• ask a family member to observe sleep

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Sleep Rest Pattern
• Physical exam
• impact of sleeping pattern and difficulty
• impact of sleep medication

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Cognitive-Perceptual Pattern
1. Cognition
• Have there been any noticeable changes in your memory and
thinking?
• Memory
• Communication
• Orientation
• Functional

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Cognitive-Perceptual Pattern
2. Perception
• Sensory system: vision, olfaction, auditory, tactile (numbness),
gustatory
• Pain assessment: OLDCARTS/ COLDSPA

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Cognitive-Perceptual Pattern
Cognitive
• LOC, MMSE, apraxia, agnosia, delirium

Sensory
• visual fields, Snellen chart
• olfaction: smell
• auditory: whisper test, check for impacted cerumen
• pain and temperature sensation
• kinesthetic: observe for one sided neglect

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Self-Perception Self-Concept
Pattern
• General: How do you feel about yourself as a person? Are you happy
with the person you are right now? How would you describe yourself?
body image disturbance

• Self-perception: self-acceptance, self-worth, and recognition

• Affective/ psychological: GDS, sadness, anhedonia, worthlessness,

sense of loss, guilt, lack of motivation, nervousness
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Self-Perception Self-Concept
Pattern
• Pyschosocial development: ego integrity vs despair (self-fulfillment)

• Affection/ psychological: affect, range of emotions

• Goals: identify of at risk of depression or suicide

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Role-Relationship Pattern
• General: How would you describe your role within your family and
community? What do you consider your most important role?

• Roles: Formal roles and informal roles

• Marital status, family situations, and living arrangement, family members,

financial situation

• Relationship/ socialization: social isolation, quality of relationship, conflicts,

relocation trauma
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Role-Relationship Pattern
• Destructive relationship/ elder mistreatment
• risk factors: female gender, advanced age, black, low income, living
alone, functional deficits, and cognitive impairment
• shortened life span
• alleged abuser: interview separately
• abuse, violence, neglect, self-neglect

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Role-Relationship Pattern
• Physical examination
• Observation of social patterns: frequency and patterns of
interaction with family and friends, decision making patterns, type
of assistance provided by family and friends

• Role assessment
• Caregiver burden/ burnout, report for suspected elder
mistreatment

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Role-Relationship Pattern
• Elder mistreatment examination
• 3 situations:
a. older adult with unusual injuries
b. an older adult with multiple risk factors for abuse or neglect
c. or any situation in which the nurse has a high index of
suspicion for elder mistreatment

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Role-Relationship Pattern
• Elder mistreatment examination
• General survey: observe hygiene
• screening: cognitive impairment functional deficits
• physical exam: body injury, bruise, fracture, laceration, burns,
observe surroundings

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Sexuality-Reproductive Pattern
• Uncomfortable to discuss but topic should not be omitted
• Introduction:
• Are you sexually active? -> Have you recently been physically
intimate with someone?
• warm, close, non-sexual relationships
• history of rape, domestic violence, child abuse
• STDs
• Sexual difficulties or changes, medication
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Sexuality-Reproductive Pattern
• Sexually active: gender and number of current and past partners, type
of intercourse (oral, vaginal and anal), patterns and frequency,
changes, current problems
• Intimacy needs being fulfilled?
• Partner's physical and/or sexual health
• barriers: condoms

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Sexuality-Reproductive Pattern
• Women:
• dyspareunia
• insufficient vaginal lubrication
• itching or burning genitals
• decreased desire
• signs of STD (malodor, discharges, rash, etc)

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Sexuality-Reproductive Pattern
• Men:
• painful intercourse
• erectile dysfunction
• decreased desire
• premature ejaculation
• medications
• Signs of STDs

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Sexuality-Reproductive Pattern
• Pay attention to verbal and non-verbal congruency- does the verbal
content and enthusiasm with which they describe sexuality and
intimacy indicate satisfaction?

• Screening examination- Testicular exam, Digital rectal exam, breast

exam

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Coping-Stress Tolerance Pattern
• General: How would you currently describe your overall stress level? Is it at
a low, moderate, or high level?
• Stress assessment- What are the current causes of and contributors to
your stress? Are they temporary or permanent? Have you been going
through a lot of changes?
• Stress management- What are you currently doing to manage your stress?
• Loss: loved one, prestige, status, valued possession, divorce, change in
environment, financial and health status

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Coping-Stress Tolerance Pattern
• Objective assessment
• Do they need professional help?
• use of food, drugs, alcohol, or suicide attempts
• healthy stress-reducing activities: keeping a journal, gardening,
listening to music, crafts, cooking, caring for a pet or exercising

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Value-Belief Pattern
• Introduction: Acknowledge that each person has unique belief and it
is important for the nurse to learn more about this to make it better.
• Values/ beliefs: What are your values and beliefs about spirituality? Do
you actively practice your faith? Do you consider yourself spiritual? Are
you involved in a religious community?Do you seek religious guidance?
• Barriers
• Internal conflict
• Open ended-question
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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

VISUAL DEFICIT
• Position self in full view of the patient
• Provide diffused, bright light; avoid glare
• Ensure patient's glasses are worn, in good working order and clean
• Face patient when speaking; do not cover mouth

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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

HEARING DEFICIT
• Speak directly to patient in clear, low tones at a moderate rate; do not
cover mouth
• Articulate consonants with special care
• Repeat if patient does not understand question initially, and then
restate
• Speak towards patient's good ear
• Reduce background noises
• Ensure patient's hearing aid is worn; turned on and working well
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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

ANXIETY
• Give patient sufficient time to respond to questions
• Establish rapport and trust by acknowledging expressed concerns
• Determine mutual expectations that indicate an interest in learning about
the patient
• Explain why information is needed
• Use a conversational style
• Allow for some degree of life review
• Offer a cup of tea, coffee, or soup
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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

REDUCED LEVEL OF ENERGY

• Position comfortably to promote alertness
• Allow for more than one assessment encounter; vary the meeting
time
• Be alert to subtle signs of fatigue, inability to concentrate, reduced
attention span, restlessness and posture
• Be patient; establish a slow pace for the interview

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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

PAIN
• Position patient comfortably to reduce pain
• Ask patient about degree of pain; intervene before interview or
reschedule
• Comfort and communicate through touch
• Use distraction techniques
• Provide a relaxed “warm” environment

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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

MULTIPLE AND INTERRELATED HEALTH PROBLEMS

• Be alert to subjective and objective cues about body system and
emotional and cognitive function
• Give patient the opportunity to prioritize physical and psychosocial
health concerns
• Be supportive and reassuring about deficits created by multiple
diseases
• Complete full analysis on all reported symptoms
• Be alert to reporting new or changing symptoms
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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

MULTIPLE AND INTERRELATED HEALTH PROBLEMS

• Allow for more than one interview time
• Compare and validate data with old records, family, friends and
confidant

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PATIENT FACTORS AFFECTING HISTORY
TAKING AND RECOMMENDATIONS

TENDENCY TO REMINISCE
• Structure reminiscence to gather necessary data
• express interest and concerns for issues raised by reminiscing
• Put memories into chronologic perspective to appreciate the
significance and span of patient's life

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Summary
• CGA should focus on function; essential role of a geronotologic nurse
• older population is unique- adjustments to the traditional assessment
is necessary
• The lecture describes the adaptation the nurses should observe in the
nursing process that will help in assisting the nurse in addressing the
needs of the older adults

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