Running head: ELDER ASSESSMENT 1

Elder Assessment Paper: Aging in the Older Adult

Precious White

Cedar Crest College

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Abstract

Client J.P is 65-year-old female who lives with her husband and son in their home. She agreed to

this interview to explore the changes of aging and the impacts it has on the older adult as well as

herself. Coping mechanisms and perspective on life was discussed as it pertains to the process of

aging. Assessments within all aspects of one’s health was performed on the client, with her

permission. Based on these assessments, two main problem areas were identified and broken

down into nursing diagnoses. Nursing diagnoses were then used to compile care plans

specifically to the client’s current issues.

Keywords: aging, older adult, health, independence, life, support, nutrition, mental health
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Health Assessment and History

Activities of Daily Living (ADL’s)

Understanding and anticipating the requirement of assistance with routine self-care in the

older adult, is vital in determining and guiding their level of care. Thus, intervening early on can

assist in preventing falls and the cause/worsening of medical conditions. According to the Katz

Index of Independence in Activities of Daily Living scale by Katz, Down, Cash, & Grotz (1970)

client J.P. scored a total of six points out of a possible score of six; meaning she is independent

in the areas of: bathing, dressing, toileting, transferring, continence, and feeding (see Appendix

A for scale used).

Instrumental Activities of Daily Living (IADL’s)

While the lack of ADL’s may hinder an older adult from independently functioning and

living, the lack of IADL’s may not. ADL’s are the foundational functions of everyday life, where

IADL’s are inessential skills that promote and support independence. A scale by Lawton and

Brody (1969) names the IADL categories as: ability to use the telephone, shopping, food

preparation, housekeeping, laundry, mode of transportation, responsibility for own medications,

and the ability to handle finances (see Appendix B for scale used). Client J.P. scored a total of

eight points on a scale from zero to eight; meaning she has a lower level (to none at all) of

dependence in these elective activities of life (Lawton & Brody, 1969).

Communication

Sight. As the older adult ages, their eyesight diminishes. These changes can be described

as: a decrease in accommodation, focus, pupil size, and the yellowing of the lens which leads to

the impairment of the eyes’ function. Client J.P. was asked to read a paragraph of small print
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from a newspaper at about 14 inches from her face. Corrective lenses were not used, as the client

does not wear any. She was able to read the paragraph in full without any issues. While assessing

her eyes, she stated that her last eye exam was during the summer of last year with no history of

vision problems (personal communication, March 11, 2017). The assessment results were: pupils

2 mm in size, pupils equal and round, and pupils reactive to light with accommodation.

Hearing. Changes in hearing in the older adult heavily impacts communication. One

must learn when dealing with hearing impaired clients how to: not speak with such high-pitched

tones, slowly speak (repeating if necessary), not shouting while speaking (as this does not help

with understanding), inform the client before touching him/her, and try to reduce

background/environmental noise. Based on the Hearing Handicap Inventory for the Elderly

Screening by Ventry and Weinstein (1983) client J.P. scored a total of two points on a scale of

zero to forty; meaning there is no hearing handicap present (see Appendix C for screening used).

Speech. During the interview with the client, speech was observed to be clear and

without disturbances.

Economic Status

Economics, as overwhelming as it can be to any normal or younger adult but especially in

the older adult, heavily influences the quality of life. Some of the important aspects of economic

status are: living wills, a power of attorney (financial/medical), health insurance, current living

situation, finances, and long term care plans. Most of this was touched upon briefly as the client

became somewhat guarded with the in-depth nature of the questions. Client J.P. stated that a

living will was constructed a while ago because her daughter, who is a nurse, made sure of it

(personal communication, March 11, 2017). Her power of attorney, appointed to her son, deals
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with the finances; and her durable power of attorney, appointed to her daughter, deals with the

medical decisions. Client J.P. currently has AARP and Medicare as her health insurance. She

used to live with her husband alone until her son moved in, just last year, to help her take care of

her husband. She states that finances are not an issue or a matter of whether to pay the bills

and/or put food on the table (personal communication, March 11, 2017). And as far as plans for

long term care, client J.P. stated she has not thought about that; and if anything, she plans on

staying in her home with her husband until death decides otherwise (personal communication,

March 11, 2017).

Living and Home Environment

Utilizing the Home Safety Self-Assessment Tool (HSSAT), risk for falls were determined

based on a wide variety of potential hazards throughout the home. According to Tomita,

Saharan, Rajendran, Schweitzer, and Nochajski (2014) 13 potential hazards were identified

pertaining to: the entrance to front door and front yard, entrance to back/side door, hallway of

foyer, loving room, kitchen, bedroom, bathroom, and staircases (see Appendix D for

questionnaire). Solutions that were discussed with the client were: adding a hand holder

alongside the front and back doors for stability, getting rid of the clutter all together but

specifically in tighter/smaller areas by creating hooks for items, getting rid of throw rugs

throughout home to prevent tripping, organizing kitchen items to eliminate reaching to high

cabinets, putting the telephone and nightlight near the bed in the bedroom, and overall lighting to

ensure adequate seeing conditions (Tomita et al., 2014).

Mental Health
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Cognitive. The cognitive assessment performed on client J.P. was the Mini Cog by

Borson, Scanlan, Brush, Vitallano, and Dokmark (2000) which yielded a negative screening for

dementia, based on the total score of four points, on a scale of zero to five (see Appendices E &

F for assessment details).

Depression. Based on the Geriatric Depression Scale: Short Form by Sheikh and

Yesavage (1986) client J.P. received a total score of five after answering the questions (see

Appendix G for questionnaire). Even though the scale specifies greater than five suggests

depression, a few more exploratory questions was asked to have client J.P. elaborate on why she

feels the way she does. She explained that although she has given up much of her life to take care

of her husband, there is nothing more that makes her happier (personal communication, March

11, 2017).

Physical Health and Nutrition

Client J.P. stated to continue to look as good as she does, good health/hygiene and

nutrition is key (personal communication, March 11, 2017). A comprehensive assessment was

done on the client and yielded: a past medical history (PMH) of a deviated septum, osteoporosis,

thyroid cancer, atrophic vaginitis, and fatigue; a past surgical history (PSH) of a breast

lumpectomy, hemorrhoid surgery, and total thyroidectomy; and a current medical history of

osteoporosis and fatigue. Current medications that the client is taking are levothyroxine and

vitamins. She states she consumes a low sodium and fat diet and denies the use of tobacco or

alcohol (personal communication, March 11, 2017). Client J.P.’s vitals were: temperature 97.6

degrees Fahrenheit, heart rate (HR) 70 beats per minute (bpm), blood pressure (BP) 132/84,

respirations 18, and a zero on a pain scale of zero to ten. Her nutrition status was determined

using a Mini Nutritional Assessment (MNA) by Kaiser, Bauer, Uter, Donini, Stange, Volkert, …
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Seiber (2011) which concluded that client J.P. was at risk for malnutrition based on a score of 10

(see Appendix H for questionnaire). Client was shocked at this finding, and stated there is no

way that the assessment was right (personal communication, March 11, 2017). She was reassured

that this was just an assessment based on how she answered the questions and may not be as

accurate as it could be. A look around the kitchen was done to observe the types of food bought

and meals prepared. There were a lot of whole grain pasta, chicken, and beef. Most of it, if not

all of the food, was organic. Client J.P. had mostly fresh vegetables with some frozen ones in the

deep freezer. There were not that many sweets, but ice cream sticks were observed in the deep

freezer. She states she prepares the meals for the most part, but her son who also lives there,

cooks at times (personal communication, March 11, 2017). Client J.P. describes a typical day to

include: oatmeal with fruit and orange juice for breakfast, some cooked meat with vegetables for

lunch, another cooked meat with vegetables and pasta for dinner, and water throughout the day

(personal communication, March 11, 2017). What was observed would be considered

appropriate nutrition wise

Spirituality

The client expressed believing in God and having faith in his will (personal

communication, March 11, 2017). Based on the FICA Spiritual History Tool by Puchalski (2006)

the client was able to reflect on her thoughts and feelings about life and what is most important

(see Appendix I). She states how important her husband and family is to her and that living her

life means living what was destined by God, for her (personal communication, March 11, 2017).

Social Support
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Having social support and a support system overall is vital in coping with stressors in life.

Some may need additional guidance and/or reassurance; and may not have that safety net of

family and friends to turn to. Understanding that the older adult needs resources and outlets to

maintain a spiritually healthy life worth living, assessment of support should always be

conducted. In client J.P.’s case, her family is her support system; but she also knows about

outside resources if she were to ever need them like church and support groups within the area.

Impact of Aging and Coping Mechanisms

Aging in the older adult can negatively impact the adult’s perspective on health and life

in general. A combination of: loneliness, self-doubt/worth, depression, and no support system are

just a few that when integrated can have a detrimental (and at times fatal) effect. Research by

Raut, Singh, Subramanyam, Pinto, Kamath, and Shanker (2014) states:

Whatever relationship they share, the mutually synergistic relationship of loneliness and

depressive symptoms are responsible for increasing negativity in lonely and depressed

individuals, and suggest that interventions at either or both fronts could reduce emotional

suffering and improve well-being. (p. 21)

Once this state of well-being is achieved, one can enjoy their older adult years rather than harp

on the unfavorable stigma of getting older. In client J.P.’s case, she has reached that state of

well-being and content. She copes with changes by being optimistic and putting her faith in her

higher power. Raut et al. (2014) explains that, “Another study showed that emotion focused

coping such as acceptance and passivity are commonly used coping strategies in them [older

adults]” (p. 21). Client J.P described how aging has impacted her life by making her wiser and

more patient; as she understands that everyone was placed on this Earth with a specific purpose

(personal communication, March 11, 2017).

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Identification of Problem Areas

The two main problem areas that are most important to J.P. are living/home environment

and mental health. Falls are important in the older adult population as it is greatly influenced by

the aging health of older adults, and can in turn negatively affect health and medical conditions.

Baroreceptors decrease and the urge to void increases which are two main contributors to falls.

Based on research done by Edelman and Ficorelli (2012):

About one of every three older adults who lives in the community falls once every year.

Falls are the primary cause of injury-related deaths in this population, and many of these

deaths occur after months of medical care and treatment. (p. 65)

Mental health is not usually priority when determining problem areas as much as physical

medical conditions are. But, each patient is unique and individualized therefore causing mental

health to be an exemption in this case. Client J.P. is not necessarily depressed but is at risk for

depression. Depression is common in the older adult and should not be taken lightly as it could

serve as an underlying issue of certain health conditions. Research done by Aakhus, Flottorp, and

Oxman (2012) supports this idea in stating, “Depression in the elderly is common and exhibits a

distinctive phenomenology, due to neurobiological, physiological, psychological and social

changes related to ageing” (p. 237).

Nursing Diagnoses

One nursing diagnosis for the living/home environment problem area is Risk for falls as

evidence by the clutter, no hand holders and throw rugs throughout the house. A goal would be

to remain free of falls for at least the next year. Two interventions can include evaluate and

remove safety hazards from the home, and provide educational resources. Rationales for these
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interventions as explained by Doenges, Moorhouse, and Murr (2010) include: Clearing of

hazards may result in a decreased risk of falls, and “For later review and reinforcement of

learning” (p. 337). Another nursing diagnosis for this problem area is Deficient knowledge of

safety related to possible home hazards as evidence by insufficient lighting in the bedroom, the

maintenance of clutter, and the reaching to high cabinets. A goal would be to initiate necessary

changes by the end of the week. Two interventions can include educating patients alongside their

caregivers, and providing additional learning material. Rationales for these interventions as

explained by Doenges et al. (2010) include: the caregivers can help with teaching, and “May

assist with further learning and promote learning at own pace” (p. 499).

One nursing diagnosis for the mental health problem area is Risk for situational low self-

esteem as evidence by taking on the burden of taking care of her husband. A goal would be to

acknowledge and verbalize the precipitating factors that may lead to such feelings by the end of

the interview. Two interventions could include to determine the client’s awareness of herself

within the situation, and identify previous adaptations to similar situations in life. Rationales for

these interventions as explained by Doenges et al. (2010) include: “When client is aware of and

accepts own responsibility, may indicate internal locus of control” (p. 724), and “May be

predictive of current outcome” (p. 728). Another nursing diagnosis for this problem area is

Fatigue related to psychological and physiological factors as evidence by PMH, not feeling full

of energy (as answered on the FICA assessment), and taking on the burden of taking care of her

husband. A goal would be to “identify basis of fatigue and individual areas of control” (Doenges

et al., 2010, p. 352). Two interventions could include to review medication regimen and dosage,

and to monitor responses to activities. Rationales for these interventions as explained by

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Doenges et al. (2010) include: “Certain drugs are known to cause and/or exacerbate fatigue” (p.

352), and “can indicate the need to alter activity level” (p. 355).

As stated by Dionigi (2015), “Both positive and negative stereotypes of aging can have

enabling and constraining effects on the actions, performance, decisions, attitudes, and,

consequently, holistic health of an older adult” (p. 1). It is up to each older adult whether to let

these stereotypes consume their lives which can cause illness; or can be the complete opposite

and be proactive while enjoying the older adult years.

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References

Borson, S., Scanlan, J., Brush, M., Vitallano, P., & Dokmak, A. (2000). The Mini-Cog: A

cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.

International Journal of Geriatric Psychiatry, 15(11), 1021-1027.

Doenges, E.M., Moorhouse, F.M., & Murr, C.A. (2010). Nurse’s pocket guide: Diagnoses,

prioritized interventions, and rationales. Philadelphia: F.A. Davis Company.

Kaiser, M.J., Bauer, J.M., Ramsch, C., et al. (2009). Validation of the Mini Nutritional

Assessment Short-Form: A practical tool for identification of nutritional status. Journal

of Nutritional Health Aging, 13, 782-788.

Katz, S., Down, T.D., Cash, H.R., & Grotz, R.C. (1970). Progress in the development of the

index of ADL. The Gerontologist, 10(1), 20-30.

Lawton, M.P., & Brody, E.M. (1969). Assessment of older people: Self-maintaining and

instrumental activities of daily living. Gerontologist, 9(3), 179-186.

Puchalski, C. (2006). Spiritual assessment in clinical practice. Psychiatric Annals, 36(3), 150-

155.

Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS). Recent evidence and

development of a shorter version. In T.L. Brink (Ed.). Clinical Gerontology: A Guide to

Assessment and Intervention, 165-173.

Tomita M., Saharan S., Rajendran S., Schweitzer J., & Nochajski S. (2014). Development,

psychometrics and use of Home Safety Self-Assessment Tool (HSSAT). American

Journal of Occupational Therapy, 68(6), 711-718.

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Ventry, I.M., & Weinstein, B.E. (1983). Identification of elderly people with hearing problems.

ASHA, 25, 37-42.