The Challenge of Assessing an Older Adult

 For a variety of reasons, the elderly may not provide a good history or description of
their health status.
 Be familiar with the changes brought about by the aging process in
order to distinguish normal changes from pathology.
 Elderly frequently do not report symptoms that they feel nothing can be done about
or that they dismiss as merely the normal changes of aging. They also may fear
hospitalization or institutionalization.
 Ask specific questions about potentially important symptoms and use
other sources of information, such as test or laboratory values, to
determine whether any adverse health condition is present.
 Older adults, particularly the frail elderly, may have multiple and chronic
complaints.
 Listen for new or changing symptoms that might indicate potentially
treatable conditions.
 The presentation of illness in the elderly is often nonspecific. Rather than coming
with specific, well-defined symptoms and signs of disease, older adults present with
vague complaints or report deterioration
Although majority ofin theirpeople
older ability to do everyday tasks.
experience important symptoms
frequently, less than 1/3 consult a
physician regularly!

A. The Setting

• Ensure the safety and comfort of the older person.

• Wheelchair accessible? Allow movement by those older people who use
canes or walkers?
• Chairs and examining table should be designed to enable older adults with
limited or painful mobility to sit and arise easily.
• Adequate lighting with reduced glare

B. Effective Communication

• Establish an atmosphere of trust and mutual respect with the older

person.
• Explain the purpose of the evaluation, what type of questions will be
asked, and what, if any, standardized or laboratory tests will be used.
• Demonstrate your respect for the older person by addressing them
formally as Mr. or Mrs.
 • Do not assume cognitive losses – Do NOT patronize!

Special Note:

Allow sufficient time to complete a comprehensive assessment.

• Geriatric histories, by virtue of the number of years they cover and the
multiple interrelated problems of the elderly, are often very complex.
• Information from many sources--medical charts, standardized tests, and
laboratory procedures--may need to be integrated into the assessment.

C. Absence of Complaints of Typical Symptoms of Disease

• Elderly patient may not provide a good history or description of their

health status.
• Nurse must be familiar with the changes brought about by the aging
process so in order to distinguish normal changes from pathology.
• Ask specific questions about potentially important symptoms and use
other sources of information, such as test or laboratory values, to
determine whether any adverse health condition is present.
• Older adults, particularly the frail elderly, may have multiple and chronic
complaints. Listen for new or changing symptoms that might indicate
potentially treatable conditions.
• Presentation of illness in the elderly is often nonspecific. Rather than
coming with specific, well-defined symptoms and signs of disease, older
adults present with vague complaints or report deterioration in their ability
to do everyday tasks.

E. Functional Assessment

A functional assessment measures the person's ability to perform self-care and to fulfill
social roles of everyday life. Functional assessment is one of the hallmarks of the
geriatric assessment, distinguishing it from the evaluation of a younger person. Because
many conditions affecting the elderly are chronic in nature, achieving a complete cure is
often unrealistic.

• Objectives of health care are improving or maintaining the functional abilities

and the overall quality of life of the older person.
• By identifying the older person's current level of functioning and determining
where improvements can be made, a functional assessment enables those
objectives to be achieved.
• Activities of Daily Living
o ADLs, (Activities of Daily Living)
 Personal care--feeding, being continent, transferring, toileting,
dressing, and bathing. Normally, these activities are performed
 independently. As the frail elderly become progressively unable to
do these tasks, they require more and more caregiving assistance.
o IADL’s (Instrumental Activities of Daily Living)
 Tasks necessary for independent functioning in the community.
They include cooking, cleaning, doing laundry, shopping, using
the telephone and means of transportation, taking medicines, and
managing money.
o AADL’s (Advanced Activities of Daily Living)
 Social, recreational, and occupational activities that greatly affect
the individual's quality of life are advanced activities of daily
living (AADLs). Playing bridge, bowling, doing crafts, or
volunteering for one's church or synagogue are examples of
AADLs. A change in the individual's normal pattern of AADLs
may be by choice or may signal a decline in health or overall
functioning.

Note: ADL’s may be assessed through self-report, but may not be accurate since the
older adults may tend to minimize deficits. Direct observation is the most accurate
measure of functional status..