Stanhope: Foundations of Nursing in the Community: CommunityOriented Practice, 3rd Edition

Community Assessment AppliedStudent Version Geriatric Population GENERAL ASSESSMENT INFORMATION Phase One: Defining the Community One population that can be used for a community assessment is a geriatric aggregate. Geriatric populations can be found in various places in a community, including volunteer organizations, senior citizen centers, community activity centers, and nursing homes. Clearly delineate the following dimensions before starting the process of community assessment: Who is the specific population that is being assessed? What is the role of this population within the community? What are the boundaries of this group? Does this community exist within a certain neighborhood? Are there geographic boundaries that separate this group from others? Is the community limited to a specific setting? Where is this group located? Why is a community assessment being performed? What purpose will it serve? When will the community assessment be conducted? Are there time limitations for completing the assessment? What resources are available to fund the community assessment? Phase Two: Assessment After the community has been defined, the next phase is assessment. On the following pages, several resources and methods are described that can be used for data gathering and data generation. This is not intended to be an all-inclusive list of resources and methods but rather a starting point for data collection and generation during your community assessment. Available monetary resources and the time frame for completion of the assessment may influence which methods are used. Nonetheless, these items should be reviewed to determine what information will be useful and should be collected about the community that is being assessed. It is not necessary to use all of these resources and methods; however, using a variety of methods is helpful when trying to discover the needs of a community. A. Data Gathering (collecting information that already exists) Demographics of the Community

When demographic data are collected, it is useful to collect data from a variety of levels, so that comparisons can be made. If the population being assessed is located within a specific setting, it may be best to contact that agency to retrieve specific information about the population. The following resources provide a broad overview of the demographics of a city, county, or state: American FactFinderFind population, housing, economic, and geographic data for your city, based on U.S. Census data: http://factfinder.census.gov/home/saff/main.html?_lang=en State and County QuickFactsEasy access to facts about people, business, and geography, based on U.S. Census data: http://quickfacts.census.gov/qfd/ Epodunk: The Power of PlaceObtain information from the U.S. Census Bureaus 2000 Census about a specific city or county and links to other useful websites: www.epodunk.com U.S. Census Bureau: www.census.gov/main/www/cen2000.html

Information From Government Agencies Healthy People 2010This resource, published by the U.S. Department of Health and Human Services, identifies health improvement goals and objectives for the country to be reached by the year 2010: www.healthypeople.gov/ Administration on AgingA division of the U.S. Department of Health and Human Services, this website provides information on how to find local agencies on aging for each state. These agencies may provide information about the geriatric population by state: www.aoa.gov/AoARoot/AoA_Programs/OAA/How_To_Find/Agencies/find_agencies. aspx National Center for Health StatisticsThis agency is part of the Centers for Disease Control and Prevention (CDC); this website provides statistical information about the health of Americans: www.cdc.gov/nchs/Default.htm Federal agencies with statistical programs: www.fedstats.gov/agencies Every state in the United States also has its own specific health improvement plan and goals that are based on the Healthy People 2010 document. This information may be available on the particular states health department website. State and local health departments also provide information related to vital statistics for the community. Other Data Sources National Family Caregivers AssociationThis website provides information about the caregivers of the frail and disabled elderly in America; caregiving statistics and

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survey and report data may be found here: www.thefamilycaregiver.org/index.cfm American Geriatrics SocietyThis organization is devoted to improving the health and quality of life of older people. This website has many links to other organizations that work with and for the older adult population: www.americangeriatrics.org/links/ Hartford Institute for Geriatric NursingThis website contains assessment tools that may be used with elderly individuals, ideas about assessment strategies, and tools that can be used with a geriatric population. Also available at this site are editorials related to geriatrics, as well as information regarding research, publications, and white papers: www.hartfordign.org/research AssessNowDeveloped through a joint project between the Washington State Department of Health and the University of Washington Northwest Center for Public Health Practice, this site contains links to a wide variety of Internet resources for all 50 states: www.assessnow.info/ Other relevant data sources may be found by conducting Internet searches related to the topic being examined through the community assessment. After data are collected from various sources, it is important to review the information and to identify assets and areas of needed improvement in the community by comparing local data (if available) against state and national data. This will facilitate organization of the information that has already been obtained and will provide direction for the next step of the process. B. Data Generation (data are developed that do not already exist) Windshield Surveys With the use of public transportation or by driving a vehicle around the community, you can assess common characteristics of the community. Key observations to make during a windshield survey include the following: Age of the homes in the community Location of parks and other recreational areas Amount of space between homes and businesses Neighborhood hangouts Transportation in the community Quality of streets and sidewalks Types/numbers of stores and other businesses People out in the community Cleanliness of the community Billboards or other media displays Places of worship Participant Observation
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Spend time observing the population you are assessing. Through observation of interactions among group members, much can be learned about the community, including the following: Developmental stage of the population Relationships among group members Group processes among members Informant Interviews Informants may be people who are familiar with and interact with the population on a regular basis. When you are working with a geriatric population, it may be beneficial to interview health care personnel, informal leaders in the community (e.g., clergy, activity leaders, volunteer coordinators, community organizers), and any other individuals who have regular contact with the population. Examples of information you can obtain from key informants include the following: Strengths/assets of the community Areas of improvement for the community Concerns of community members Access to health care Focus Groups Use of focus groups (usually small groups of 6 to 12 people) can be helpful when you are gathering information about specific areas of concern within the population. Focus groups provide information through open dialogue about the population, whereas an interview or survey yields only individual responses. Using focus groups may be effective for assessing the following: Satisfaction with services provided Community resources used Transportation issues within the community Safety within the community General concerns of population members Surveys Surveys can be used to collect data from the community. Selecting a sample of the target population may prove helpful in the collection of data that are easier to analyze. It is important to ensure that the sample is representative of the target population. A survey should be developed that takes into consideration the developmental level of the group being assessed. Questions should be written at the appropriate developmental level, so they are answered in a way that makes the data useful. Surveys can include any of the following types of questions: closed-ended (yes/no), multiple choice (several responses to choose from), Likert scale (strongly agree/agree/neutral/disagree/strongly disagree), or open-ended (why/how).

Community Assessment AppliedGeriatric, Student Version Topics that may be addressed in a survey include the following: Demographic information Status of employment Safety within community Personal safety (seatbelts, helmets, etc.) Stressors/stress management patterns Risky behaviors Support systems Volunteer/community activities Hobbies Activity and rest patterns Nutrition Dental hygiene Health promotion activities

Secondary Analysis of Already Existing Documents After collected data have been analyzed, it may be helpful to go back and review the documents that were collected during the data-gathering phase or to find additional data that have already been collected by another source. C. Data Interpretation After the data have been collected, it is important to analyze the information to identify any significant themes or trends. This can be done by organizing the information that has been collected during data gathering and data generation. Answering the following questions may assist in data interpretation: What similarities are apparent between the data that were gathered and the data that were generated? What differences are apparent between the data that were gathered and the data that were generated? What are the strengths of this community? In what areas is improvement needed in this community?

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EXAMPLE:: COMMUNITY ASSESSMENT APPLIED Phase One: Defining the Community You are employed as a public health nurse by the Centerville Area Agency on Aging. One of your duties in this position is to provide health services to older persons in the community. Services currently provided by this agency consist of a congregate meal site and a foot clinic. You wonder whether these services are meeting the needs of the target population and whether additional services should be offered. Thus you decide to perform a community assessment on the older population that resides in Centerville. Phase Two: Assessment A. Data Gathering First, you conduct an Internet search to find information about your population. Through your search, you gather the following information: National DataU.S. Department of Health and Human Services Statistical Profile of Older Americans Aged 65+ (Retrieved from Administration on Aging website: www.aoa.gov/AoARoot/Aging_Statistics/index.aspx) The older population increased by 9.4% from 1995 to 2005. About 12.4% of the population consists of older Americans. Older women are more numerous than older men. Older men were much more likely to be married than older women. In 2005, the median income among older persons was $21,784 for males and $12,495 for females. The main source of income for older persons in 2004 was Social Security (89%). About 10.1% of older persons were below the poverty level in 2005. In 2004-2005, 38.1% of older persons living in the community rated their health as excellent or very good; this is low when it is considered that 66% of persons aged 18-64 rated their health as excellent or very good. The most frequently reported health conditions in this population in 2003-2004 were hypertension (52%), diagnosed arthritis (50%), heart disease (32%), cancer (21%), and diabetes (17%). State DataGeriatric Population (2005) A total of 14% of the population was older than 65 years. Median income for an older person was $14,000. The poverty rate for older persons was 10%; rate for the remaining population was 7.5%. Leading causes of death among older persons included heart disease (35%), cancer (20%), stroke (8%), and chronic obstructive pulmonary disease (COPD) (6%). Local Data Centerville population: 6500

Community Assessment AppliedGeriatric, Student Version Centerville population 65 years or older: 1500 (25% of the population) Ethnicity: White or Caucasian: 95% Black or African American: 3% Latino or Hispanic: 2% Median income for older persons (age 65+) is $27,000; median income for all households is $29,000.

After collecting data from the Internet, you visit the community center to get information about services provided and to review the records of services provided at the Area Agency on Aging. Community Center Data Bingo: Approximately 40 people attend the weekly bingo game held on Wednesday afternoon. Exercise program: Approximately 25 people attend the exercise program that is held on Tuesday morning. Congregate Meals One meal site is available within the community; it is located in the community center and serves a midday meal Monday through Friday. Approximately 30 older persons attend the meal each day; approximately 100 people attend a meal at least once a month. The number of persons who attend the meals has not significantly changed during the past decade. Most persons who attend congregate meals are retired and live on a fixed income. Foot Clinic A foot clinic is available for older persons in the community. It is located at the main office for the Area Agency on Aging on Main Street. A nurse operates the foot clinic from 9 a.m. to 11 a.m. every Thursday. Older persons can sign up for a 30-minute appointment by calling the Area Agency on Aging. During the visit, the nurse assesses vital signs, inspects feet, trims toenails if needed, and provides education to older persons. Appointment times always fill up quickly, and sometimes, individuals will wait up to a month to get in to see the nurse. The Area Agency on Aging has been given a state grant to operate the foot clinic, so at this time, no fee is charged for services provided. B. Data Generation After collecting the previous information, you begin to generate your own data about the community. You choose to conduct a focus group at the congregate meal site to gather additional information. To prepare for the focus group discussion, you select main topics that you would like to discuss with the group. You prepare a topic list rather than a list of specific questions, because you want to allow the group to guide the direction of the discussion. Your list of topics: Services currently used
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Accessibility of current services Barriers to use of current services Recommendations for additional services

Next, you contact the director of the community center where the congregate meal is served and ask him to help you organize a small group of older persons (6-12 persons) for the focus group. You explain that the purpose of the focus group is to talk about services that are currently provided for older persons in the community, discuss ways to improve these existing services, and explore suggestions for additional services that may be offered. The director states that he will organize the focus group after you let him know the day and time you would like to come to the community center. Focus Group As you conduct the focus group with eight older persons (three males and five females), you take notes about what the participants say; you also ask the group members questions to clarify their thoughts and learn more about their perspectives on services within the community. After you finish the focus group meeting, you look through your notes to identify emerging themes that were discussed. Theme Identification The group states that current services are available and accessible to them. However, they all state that they are able to drive and have a reliable source of transportation. They express concern for others they know in the community who are unable to use the current services because they have no way to get there. They enjoy the meals that are offered at the community center. They state that the food is good and they enjoy the companionship at meal time. They state that they wish that meals could also be delivered to those who are unable to get to the community center. They are concerned about the length of time that it takes to be seen at the foot clinic. No one is happy about having to wait up to a month to be seen by the nurse. They think that this service should be offered more frequently. Also, they state that the location is not convenient for them. It is often very difficult to find a parking space on Main Street, and all of the available spots require parallel parking, which is sometimes difficult for them to do. Because of this, some of them state that they have had to walk a couple of blocks to get to the office and that they have found this to be exhausting. They wish there was more than one doctor in town. They state that sometimes they need to see the doctor right away but are told that it will be several days before an open appointment time is available. Because of this, many drive to a neighboring town and use the emergency department; they feel they have no other options. They are concerned about the medical care they receive. They state that they are sometimes unsure about why they are taking their prescribed medications. They state that no one ever takes the time to explain their medications; everyone is always in a rush. When they see the doctor, they feel as though they are always being given another pill and that no one actually tries to find out what is really wrong with them. They wish someone would take the time to explain things to

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them. They wish there was more to do in the community. They feel fortunate to have a community center, where they can gather on a regular basis. They enjoy the activities that are offered and feel lucky after speaking to residents in other communities who do not have a community center. However, doing the same thing on a weekly basis gets boring, and they would like to have new and different opportunities available to them. Transportation is a major concern for residents of the community. The town has no public transportation system, so it is difficult to get around if you are unable to drive or do not have a reliable vehicle. They state that some of their friends rarely leave their homes because they have no mode of transportation.

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C. Data Interpretation After you have collected the data, you analyze the findings. You look through the data to determine whether you have collected adequate information to obtain a complete picture of the community. You review the data you have collected to identify recurrent themes. You identify the strengths and weaknesses of the community so that you can draw some conclusions. Topic Area: Income National/State Data Local Data

Interpretation:

Conclusion:

Community Assessment AppliedGeriatric, Student Version Topic Area: Health Conditions National/State Data

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Local Data

Interpretation:

Conclusion:

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Topic Area: Congregate Meals Data Gathered

Data Generated

Interpretation:

Conclusion:

Community Assessment AppliedGeriatric, Student Version Topic Area: Foot Clinic Data Gathered

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Data Generated

Interpretation:

Conclusion:

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Topic Area: Additional Services Data Gathered

Data Generated

Interpretation:

Conclusion:

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On the basis of the community assessment, you are able to draw the following conclusions: Strengths of the Community

Areas for Improvement in the Community

Recommendations

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