Running head: ELDER ASSESSMENT PAPER 1

Elder Assessment Paper- Section 1

0371

Cedar Crest College

ELDER ASSESSMENT PAPER 2

Elder Assessment Paper- Section 1

Older adults face a number of stressors aside from health problems that may affect their

daily living and safety. The student nurse interviewed A.A., Amelia, on September 16th, 2016.

Amelia is a 74-year-old female who lives with her husband, Jay, of 53 years. The interviewer

observed Amelias communication and emotional well-being in addition to completing multiple

written and verbal assessments. The interview took place to identify the strengths and

weaknesses of daily life that Amelia is experiencing. The student nurse finalized the assessment

by identifying two areas of concern for the older adult who was interviewed.

ADLs/IADLs

Amelia was proven highly independent by the Katz Index of Independence in Activities

of Daily Living (see Appendix A). The woman interviewed had moderate impairment,

specifically, the assessment implied that in some aspect of daily activities she was dependent on

supervision or direction as total care and personal assistance are not relevant. Although there

were no previous assessments to compare the results to, it could be assumed that Amelias health

status was gradually beginning to decline which may be directly correlated her the multiple

chronic conditions. Amelia felt as though she was fully independent and that mild urinary

incontinence was just an aging factor.

To assess IADLs, the Lawton Instrumental Activities of Daily Living Scale (see

Appendix B) was used. Amelia scored fairly independent with a total score of 5/8. The student

reflects the older adults is inability to function with complete independence. Basic

responsibilities including meal preparation, shopping, medication administration, and finances

were completed with the guidance of her husband. The sole reason Amelia was able to score as
ELDER ASSESSMENT PAPER 3

highly as she did was due to her ability to complete any one of the tasks partially. It should be

noted that these results indicate increasing impairments and could become a safety issue.

Communication

It was immediately apparent by the student nurse that Amelia has multiple sensory

deficits. Amelia stated that she wore hearing aids in both ears, reading glasses, and two full sets

of dentures. It was by no surprise that the Hearing Handicap Inventory for the Elderly Screening

Version (see Appendix C) proved maximum handicap including both social and emotional

deficits. When asked about the effects hearing aids had on her social life, Amelia responded

with, I feel bad that everyone has to repeat themselves. I cant even heard Jay or my friends talk

when were at the bowling alley. It makes me not even want to go. Amelia stated that her

doctors have spoken with her about the emotional and social aspects that hearing aids may have

on her life. The primary analysis showed a strong association between hearing loss and social

isolation in 60- to 69-year-old women but not in men or older individuals. Some sociologists

have argued that talk is the primary vehicle by which women create and maintain intimacy and

connectedness (Mick, Kawachi, & Lin, 2013, p. 380). The older adult shared that when she

originally received the hearing aids she would only wear them at home and would try to hide

them she would go out, which is not an uncommon finding for an older adult. Rates of hearing

aid use differed substantially by hearing loss severity with only 3% of individuals with mild

hearing loss reporting hearing aid use versus 41% in those with moderate or worse hearing loss

(Lin, Thorpe, Gordon-Salant, & Ferrucci, 2011, p. 588).

When signing the consent form, the student nurse observed excessive strain from Amelia.

The interviewee stated that her ophthalmologist advised her to get prescription glasses but she

didnt feel like it was necessary at the time.

ELDER ASSESSMENT PAPER 4

To complete the communication assessment, the older adult allowed the student to exam

her mouth with the dentures present. The oral cavity was pink, moist, and intact; the dentures did

not move abnormally when Amelia speaks. Amelia has had no history of oral disease. The older

adult stated that she was confident of her dentures and that she enjoys how they make her look.

Although, she shared they become uncomfortable after more than 12-hours of wearing. The Oral

Health Assessment Tool for Dental Screening (see Appendix D) proved that she had a fairly

healthy oral cavity.

Economic Status

The older adult had limited responses when asked about economic status. Amelia elicited

that because she was a stay-at-home mother, she had relied on her husband for financial support.

Her husband requested that she only spend a set amount each week, in which she obliged by. Jay

has continued to manage all bills, travel expenses, and insurance maintenance. Although her

husband was almost 77, Amelia seemed to have no concern with his ability to handle this

responsibility. Amelia furthered the conversation when she noted that her last surgery, which

was a spinal fusion, cost more than $70,000. The older adult was unable to articulate how much

the insurance was able to cover. Amelia had no known longer term care plans or durable power

of attorney. She stated that her husband did have a living will created but she was unsure of the

specifics.

Living/ Home Environment

Amelia lived in a two-story house with three staircases with her husband. The main entry

of the house was located at the top of an outside staircase that often times became wet and

slippery due to environmental factors. Amelia stated that she tries to avoid the main entry

whenever possible to avoid falling. Fortunately, inside the house, the kitchen, bathroom, and
ELDER ASSESSMENT PAPER 5

bedroom were located on the main level. It should be noted though, that her only heat source, a

woodstove, was found in the basement. Amelia was dependent on her husband to bring wood for

the stove inside to ensure the house was an adequate temperature in the winter.

The Fall Efficacy Scale-International (see Appendix E) indicated that Amelia has

somewhat of a concern of falling, especially when walking or using stairs. This can pose a

problem if the main entry becomes the only entry or if her husband is unable to maintain the

woodstove. The Tinetti Balance Assessment Tool (see Appendix F) furthered the evaluation

when the study showed that Amelia has a high risk of falling with a score of <18. Amelia stated

that she uses no ambulatory devices but tended to lend on stationary objects when walking.

With this being noted, the student nurse referred to the Home Safety Inventory (see

Appendix G). Amelias score indicated an increased risk of accidental self-harm. While being

questioned regarding the assortment of tools, appliances, and other dangerous items used,

Amelia revealed to the student nurse that she often accidently cuts her self when using knives,

scissors, and hedge trimmers.

Mental Health

Prior to beginning the cognitive assessment, Amelia requested that the interviewer and

herself move to a room separate from her husband. Once in private, Amelia disclosed that she

though of herself as slow and did not think it was appropriate for her husband to listen to her

struggle. After the student nurse reassured Amelia that all information was confidential, the older

adult stated that the cognitive difficulties were not related to age as she had noticed it her entire

life.

The Mini-Mental State Exam (see Appendix H) did exhibit signs of moderate

impairment. Amelia was able to answer all of the questions but many of which had to be re-
ELDER ASSESSMENT PAPER 6

worded and explained in depth for them to be completed. The design drawing and Clock

Drawing Test (see Appendix I) was where the student nurse noticed increased impairment.

Amelia refused to attempt either without being shown a step-by-step demonstration by the

examiner. Alzheimers was not a concern as the woman was oriented and able to recall.

The student nurse believed that this would now be an ideal time to assess Amelia for

depression by using the Geriatric Depression Scale: Short Form (see Appendix J). Amelias

results were suggestive of mild depression and require a follow-up comprehensive assessment by

a professional. The cause of this increased depression stems from inability to complete activities

and interests, helpless and lack of energy relating to her chronic conditions.

Physical Health/Nutrition

The student nurse was aware that physical health and nutrition would be a prominent area

of concern with Amelia. To begin the assessment, Amelia weighed and measured herself with

assistance from the student nurse. Amelia weighed 91-pounds and measured at 62; her BMI was

16.1 and calf circumference was less than 31 cc implying she was underweight. After being

weighed, Amelia shared that she was surprised at how little she weighed as she was never under

150-pounds in middle-adulthood.

The Mini Nutritional Assessment (see Appendix K) results were also indicative of

malnutrition. Preceding the questionnaire, Amelia voiced concern as she stated that her primary

doctor during her last hospital admission had also mentioned her malnutrition. The student nurse

began to assess Amelias recent diet by asking for a 24-hour recall. The older adult described

that most days she drinks about one half-liter bottle of flavored seltzer because its just like

water but better, has a banana for breakfast, a half a sandwich for lunch, and then a small plate

about 7:30 P.M. of the dinner her husband had made. Amelia disclosed that she doesnt cook
ELDER ASSESSMENT PAPER 7

often but when she does it was normally not a complete meal. Social and behavioral

interventions can successfully improve eating habits and nutritional status as well as physical

fitness levels (Mick, Kawachi, & Lin, 2013, p. 93).

In addition, the student nurse assessed Amelias fatigue by using the Functional

Assessment of Chronic Illness Therapy Fatigue Scale (see Appendix L). Amelias score

indicated severe fatigue, which the older adult relates to her chronic pain and sleepiness. Using

the Faces Pain Scale- Revised (see Appendix M), Amelia stated that her current pain was a 3/10.

When asked to describe her pain, Amelia described it as, Right now, Im okay, but at night it is

like a 7 or 8. The older adults described that she refuses to take pain medication to assist with

the pain. The Epworth Sleepiness Scale (see Appendix N) aided to this assessment by verifying

that Amelia was very sleepy and should seek medical advice. The woman admitted, not only

does the pain affect her daily life, but the lack of sleep related to the pain adds to her activity

intolerance.

Spirituality

As a first assessment, the student nurse used the FICA Spiritual History Tool (see

Appendix O) to evaluate the spirituality of Amelia. Amelia was hesitate to begin the

conversation but soon unveiled her true beliefs. The assessment tool allowed the examiner to

locate weakness and strength of the womans spiritual history. It appeared that Amelia

previously attended a Catholic Church service weekly but with older age her attendance

decreased. Amelia feels safe when she refers to her beliefs and although it doesnt direct her

health care fully it did have an impact. The older adult shared with the student nurse that she

often feels guilty for not attending the church service more often. The communities that she
ELDER ASSESSMENT PAPER 8

surrounds herself with from the church were many dear friends that have proved to her over the

years to be her biggest support system.

Social Support

Social support for Amelia varies from her closest family members to her friends from

Germany she met in the Dominican Republic and talks with through e-mail. Amelia stated that

she has no shortage of friends and family that will support her but refers to her husband as her

true social support. The family members that live the closest were who she considered her most

supportive relatives including her youngest granddaughter who often visits her, cleans, and takes

her to appointments when her husband was unable to. As previously mentioned, Amelias fellow

churchgoers were usually just a phone call away when her days were too stressful to handle.

Lastly, Amelia began to go into great detail about her devoted husband who has been through

every operation, procedure, and diagnosis thus far. The interviewee mentioned, with tears in her

eyes, that without her husband, she wouldnt be able to survive.

Identification of Problem Areas

There are multiple stressors aside from chronic conditions that act on older adults. The

student nurses primary concern for Amelia was related to her physical health and nutrition as

she was malnourished. Malnutrition can lead to extensive medical complications especially in an

older adult. Amelia was aware of the problem but did not seem to understand how to alter to

current condition. The older adults secondary problem assessed by the student nurse was her

loss of ability to complete hobbies as it directly correlated to her sensory deficient as well as

physical health and nutrition. Amelia stated that she does not enjoy bowling any longer because

of the emotional strain relating to her sensory deficits. Both problem areas can be detrimental for

an older adults health and emotional well-being.