NURSING AND MIDWIFERY TRAINING COLLEGE, BOLE.

COURSE:GERONTOLOGY AND HOME NURSING

GROUP PRESENTATION
GROUP ONE (1)
QUESTIONS: Assessing older adults
A. Systematic geriatric Assesment
B. Health history
C. Healthy history
D. Geriatric assesment (Functions and cognition)
A. Systematic Geriatric Assessment (SGA) is a comprehensive evaluation of an older
adult's physical, cognitive, and functional abilities. It aims to identify health
risks, improve function, optimize care, and enhance quality of life.

Components of SGA
1. Medical History: Review of medical conditions, medications, and allergies.
- Examples: hypertension, diabetes, arthritis, medication adherence, and
potential side effects.
2. Physical Examination: Evaluation of physical function, mobility, and sensory
impairments.
- Examples: assessing gait, balance, strength, vision, and hearing.
3. Cognitive Assessment: Evaluation of cognitive function, including memory,
attention, and decision-making.
- Examples: using standardized tools like the Mini-Mental State Examination
(MMSE) or Montreal Cognitive Assessment (MoCA).
4. Functional Assessment: Evaluation of activities of daily living (ADLs) and
instrumental activities of daily living (IADLs).
- Examples: assessing ability to perform tasks like bathing, dressing, managing
finances, and cooking.
5. Social Assessment: Evaluation of social support, living situation, and access to
resources.
- Examples: assessing living arrangements, social connections, and access to
transportation and healthcare.

Tools and Techniques

1. Standardized assessment tools: Using validated tools like the Activities of
Daily Living (ADL) scale, Instrumental Activities of Daily Living (IADL) scale, and
Geriatric Depression Scale (GDS).
2. Comprehensive geriatric assessment: Incorporating input from multidisciplinary
teams, including healthcare providers, social workers, and therapists.

Benefits
1. Early identification of health risks: SGA helps identify potential health
problems early, allowing for timely interventions.
2. Personalized care plans: SGA informs the development of tailored care plans that
address individual needs and goals.
3. Improved health outcomes: SGA can lead to better health outcomes, reduced
hospitalizations, and improved quality of life.
4. Enhanced patient -centerd care: SGA promotes patient -centerd care by
considering the individual's needs and preferences

Applications of SGA
1. Primary care: SGA can be used in primary care settings to identify health issues
early.
2. Geriatric clinics: SGA is often used in geriatric clinics to assess and manage
complex health issues.
3. Hospital settings: SGA can be used in hospital settings to assess older adults'
needs and develop care plans.
Challenges
1. Time and resource constraints: Conducting comprehensive assessments can be time-
consuming and require significant resources.
2. Complexity of geriatric care: Older adults often have multiple chronic
conditions, making care planning complex.

By incorporating SGA into clinical practice, healthcare providers can deliver more
effective, patient-centered care to older adults.
B. Health history
Assessing the health history of an older adult involves gathering information about
their medical past, current health status, and lifestyle. This comprehensive
assessment helps healthcare providers understand the individual's needs and develop
effective care plans.

Key Components of Health History Assessment

1. Medical history: Review of past medical conditions, surgeries, and
hospitalizations.
2. Current health status: Evaluation of current symptoms, medications, and health
concerns.
3. Medication review: Assessment of prescription and over-the-counter medications,
including dosages and potential interactions.
4. Allergies and sensitivities: Identification of any allergies or sensitivities to
medications, foods, or environmental factors.
5. Lifestyle factors: Assessment of diet, exercise, smoking, and substance use.
6. Social history: Evaluation of social support, living situation, and access to
resources.
7. Cognitive and functional assessment: Evaluation of cognitive function,
activities of daily living (ADLs), and instrumental activities of daily living
(IADLs).

Importance of Health History Assessment

1. Accurate diagnosis: A comprehensive health history helps healthcare providers
make accurate diagnoses.
2. Effective care planning: Understanding an individual's health history informs
the development of personalized care plans.
3. Medication management: A thorough medication review helps prevent adverse
interactions and ensures safe medication use.
4. Preventive care: Identifying health risks and lifestyle factors enables
healthcare providers to recommend preventive measures.
Here are the steps to assess the health history of an older adult:

Step 1: Prepare for the Assessment

1. Choose a comfortable setting: Select a quiet, comfortable setting where the
older adult feels at ease.
2. Ensure privacy: Ensure the assessment takes place in a private setting to
encourage open discussion.
3. Gather necessary tools: Gather any necessary assessment tools, such as a health
history questionnaire.

Step 2: Introduce Yourself and Explain the Purpose

1. Introduce yourself: Clearly introduce yourself and your role in the assessment
process.
2. Explain the purpose: Explain the purpose of the health history assessment and
how it will be used.
3. Establish rapport: Establish a rapport with the older adult to build trust and
encourage open communication.
Step 3: Gather Information
1. Ask open-ended questions: Ask open-ended questions to gather information about
the older adult's medical history, current health status, and lifestyle.
2. Use a health history questionnaire: Use a standardized health history
questionnaire to ensure a comprehensive assessment.
3. Review medical records: Review medical records to gather additional information
about past medical conditions and treatments.

Step 4: Assess Cognitive and Mental Health

1. Use standardized assessment tools: Use standardized assessment tools, such as
the Mini-Mental State Examination (MMSE), to evaluate cognitive function.
2. Assess mental health: Assess mental health status, including symptoms of
depression or anxiety.

Step 5: Document Findings

1. Accurately document findings: Accurately document the findings from the health
history assessment.
2. Include relevant information: Include relevant information about the older
adult's medical history, current health status, and lifestyle.
3. Use clear and concise language: Use clear and concise language when documenting
findings.

Step 6: Develop a Care Plan

1. Develop a personalized care plan: Develop a personalized care plan based on the
findings from the health history assessment.
2. Prioritize health issues: Prioritize health issues and develop strategies to
address them.
3. Involve the older adult and their family: Involve the older adult and their
family in the care planning process to ensure their needs and preferences are met.

Challenges
1. Complexity of geriatric care: Older adults often have multiple chronic
conditions, making care planning complex.
2. Cognitive impairment: Some older adults may have difficulty providing accurate
information due to cognitive impairment.
3. Communication barriers: Healthcare providers must be aware of potential
communication barriers, such as hearing or vision loss.
C. Physical assesment

A physical assessment of an older adult involves evaluating their physical health

and function. This assessment helps healthcare providers identify potential health
issues, develop effective care plans, and promote overall well-being.

Key Components of Physical Assessment

1. Vital signs: Measuring temperature, blood pressure, pulse, respiratory rate, and
oxygen saturation.
2. Body systems assessment: Evaluating the cardiovascular, respiratory,
gastrointestinal, musculoskeletal, and neurological systems.
3. Functional assessment: Assessing activities of daily living (ADLs) and
instrumental activities of daily living (IADLs).
4. Mobility and balance assessment: Evaluating gait, balance, and risk of falls.
5. Sensory assessment: Evaluating vision, hearing, and other sensory functions.

Techniques Used in Physical Assessment

1. Inspection: Observing the patient's overall appearance, posture, and movement.
2. Palpation: Using touch to assess body structures, such as pulses, masses, or
areas of tenderness.
3. Percussion: Using percussion techniques to assess lung sounds, abdominal masses,
or other body structures.
4. Auscultation: Listening to body sounds, such as heart or lung sounds.

Importance of Physical Assessment

1. Early detection of health issues: Physical assessment helps identify potential
health problems early, allowing for timely interventions.
2. Development of effective care plans: A comprehensive physical assessment informs
the development of personalized care plans.
3. Promoting functional ability: Assessing functional ability helps healthcare
providers develop strategies to promote independence and mobility.
Conducting a comprehensive physical assessment of an older adult involves several
steps to ensure a thorough evaluation of their health status. Here’s a structured
approach to performing this assessment:

▎1. Preparation

• Gather Equipment: Ensure you have all necessary tools, including a

stethoscope, sphygmomanometer, thermometer, penlight, otoscope, and any other
relevant instruments.

• Create a Comfortable Environment: Ensure privacy, adequate lighting, and a

comfortable temperature in the assessment area.

• Review Medical History: Familiarize yourself with the patient's medical

history, medications, and any specific concerns they may have.

▎2. Introduction

• Identify Yourself: Introduce yourself and explain your role.

• Obtain Consent: Explain the purpose of the assessment and obtain verbal
consent.

• Build Rapport: Engage in a brief conversation to help the patient feel at

ease.

▎3. General Survey

• Observe Overall Appearance: Note the patient's hygiene, grooming, posture, and
mobility.

• Assess Vital Signs: Measure blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.

• Evaluate Pain Level: Ask about any pain or discomfort using a standardized
pain scale.

▎4. Head-to-Toe Assessment

▎A. Neurological Assessment

• Level of Consciousness: Assess alertness and orientation (person, place,

time).

• Cranial Nerves: Check for function of cranial nerves through simple tests
(e.g., facial symmetry, visual acuity).

• Motor Function: Assess strength and coordination (e.g., hand grips, finger-to-
nose test).
 • Reflexes: Check deep tendon reflexes if indicated.

▎B. Cardiovascular System

• Heart Sounds: Auscultate heart sounds for rate, rhythm, and any abnormal
sounds (e.g., murmurs).

• Peripheral Pulses: Palpate peripheral pulses (radial, dorsalis pedis,

posterior tibial).

• Capillary Refill: Assess capillary refill time in fingers and toes.

▎C. Respiratory System

• Breath Sounds: Auscultate lung fields for normal and abnormal breath sounds.

• Respiratory Effort: Observe for use of accessory muscles or signs of distress.

▎D. Gastrointestinal System

• Abdominal Inspection: Inspect for distention, scars, or abnormalities.

• Auscultation: Listen for bowel sounds in all quadrants.

• Palpation: Gently palpate the abdomen for tenderness or masses.

▎E. Genitourinary System

• Urinary Function: Inquire about urinary habits, incontinence, or changes in

urinary patterns.

• Pelvic Examination: If appropriate and consented, perform a genital

examination to assess for any abnormalities.
▎1. Screening for Health Issues

• Sexual Health: Older adults may experience changes in sexual function, libido,
or satisfaction. Assessing the genitals can help identify issues such as erectile
dysfunction in men or vaginal dryness in women.

• Infections: Older adults are still at risk for sexually transmitted infections
(STIs), and a genital examination can help identify signs of infection or other
abnormalities.

▎2. Cancer Screening

• Prostate Cancer: In men, a digital rectal exam (DRE) may be performed to

screen for prostate abnormalities.

• Cervical and Ovarian Cancer: In women, a pelvic examination can be crucial for
cervical cancer screening (Pap smear) and to assess for other gynecological issues.

▎3. Urinary Health

• Incontinence: Many older adults experience urinary incontinence, which can

have significant implications for quality of life. Assessing the genital area can
help evaluate any underlying issues.

• Prostatitis: Men may have conditions like prostatitis that can affect urinary
function.
▎4. Skin Integrity

• Skin Changes: The genital area can show signs of skin changes, infections, or
irritation that may not be apparent elsewhere. This is particularly important in
individuals with limited mobility or who are bedridden.

▎5. Psychosocial Factors

• Body Image and Self-esteem: Changes in genital health can impact body image
and self-esteem, which are important aspects of mental health in older adults.

• Communication about Sexuality: Discussing genital health can open up

conversations about sexual health, intimacy, and relationship dynamics.

▎Considerations

• Patient Comfort: It’s essential to approach this assessment with sensitivity and
respect. Ensure the patient is comfortable and understands the purpose of the
examination.

• Cultural Sensitivity: Be aware of cultural attitudes towards genital

examinations, as they may vary widely among individuals.

• Consent: Always obtain informed consent before performing any examination of the
genital area.

▎F. Musculoskeletal System

• Range of Motion: Assess active and passive range of motion in major joints.

• Strength Assessment: Evaluate muscle strength in upper and lower extremities.

▎G. Integumentary System

• Skin Assessment: Inspect skin for color, texture, turgor, lesions, or signs of
pressure ulcers.

• Nail Assessment: Check nails for color, shape, and integrity.

▎5. Functional Assessment

• Activities of Daily Living (ADLs): Assess the ability to perform basic self-
care tasks such as bathing, dressing, eating, and toileting.

• Instrumental Activities of Daily Living (IADLs): Evaluate more complex tasks

such as managing finances, medication management, shopping, and transportation.

▎6. Psychosocial Assessment

• Mental Health Screening: Inquire about mood, anxiety levels, and cognitive
function (e.g., memory).

• Social Support: Discuss the patient's support system and living situation.

• Advance Directives: Ask about any advance care planning or directives.

▎7. Closing the Assessment

 • Summarize Findings: Provide a brief summary of your findings to the patient.

• Answer Questions: Allow time for the patient to ask questions or express
concerns.
• Plan Follow-Up Care: Discuss any necessary follow-up appointments or referrals
based on the assessment findings.

▎8. Documentation

• Document all findings accurately in the patient’s medical record, including

vital signs, observed behaviors, and any concerns raised by the patient.

Considerations in Older Adults

1. Age-related changes: Healthcare providers must be aware of age-related changes
that can affect physical function, such as decreased muscle mass or bone density.
2. Comorbidities: Older adults often have multiple chronic conditions, which can
impact physical function and overall health.
3.Medications: Healthcare providers must consider the potential impact of
medications on physical function and overall health.
D. Geriatric Assesment (Functions and Cognition)
Assessing functional and cognitive abilities is crucial in geriatric care. Here's
an overview:

Functional Assessment
1. Activities of Daily Living (ADLs): Evaluating ability to perform basic self-care
tasks, such as:
- Bathing
- Dressing
- Grooming
- Toileting
- Feeding
2.Instrumental Activities of Daily Living (IADLs): Assessing ability to perform
complex tasks, such as:
- Managing finances
- Cooking
- Cleaning
- Shopping
- Managing medications

Cognitive Assessment
1. Memory: Evaluating short-term and long-term memory.
2. Attention and concentration: Assessing ability to focus and maintain attention.
3.Language and communication: Evaluating ability to understand and express
language.
4.Executive function: Assessing ability to plan, organize, and problem-solve.

Assessment Tools
1. Katz Index of Independence in ADLs: A widely used tool to assess ADLs.
2. *Lawton Instrumental Activities of Daily Living (IADL) scale*: A tool to assess
IADLs.
3. Mini-Mental State Examination (MMSE): A widely used tool to assess cognitive
function.
4.Montreal Cognitive Assessment (MoCA): A tool to assess cognitive function,
including executive function.

Importance of Assessment
1. Identifying functional decline: Early detection of functional decline can inform
care planning and interventions.
2. Developing personalized care plans: Assessing functional and cognitive abilities
helps healthcare providers develop tailored care plans.
3. Promoting independence: Identifying areas of strength and weakness can inform
strategies to promote independence and functional ability.

Considerations
1. Comprehensive assessment: A comprehensive assessment should include both
functional and cognitive evaluations.
2. Multidisciplinary approach: A multidisciplinary team, including healthcare
providers, therapists, and social workers, can provide a comprehensive
understanding of the individual's needs.
3.Cultural sensitivity: Assessments should be culturally sensitive and take into
account the individual's values and preferences.

By assessing functional and cognitive abilities, healthcare providers can develop a

deeper understanding of an older adult's needs and provide high-quality, patient-
centered care.
INDEX NUMBERS
NMCBLPHN220012
NMCBLPHN220097
NMCBLPHN220067
NMCBLPHN220037
NMCBLPHN220078
NMCBLPHN220058
NMCBLPHN220014