07 Jun The assessment process for older clients is quite different from assessing children and adolescents. Not only is the physic
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The assessment process for older clients is quite different from assessing children and adolescents. Not only is the physical condition of the patient likely significantly different than what we would expect to see in a younger patient, but their cognitive status may also have a substantial impact on an older client’s overall condition. Geriatric clients may be struggling with a decline in their physical ability and/or a deterioration in their clinical health but may be of sound mind. This can be very frustrating to them because in such a case, they have the mental capacity to know what they want and need but may struggle to fulfill said wishes. For other older patients, physical health may be perfectly fine but they may be experiencing a severe decline in cognition that can place them at risk for injury or abuse. On top of all these factors, we must also take into account the importance and impact of cultural diversity when assessing elderly clients. Ward and Hess (2019) point out that each individual patient’s level of acculturation, language barriers, disparities in access to care, overall health literacy, and beliefs that are culturally defined must all be part of every older adult’s assessment.
Although it may seem daunting to attempt to navigate the complex process of assessing a geriatric patient, Rosen and Reuben (2011) provide excellent examples of the type of geriatric assessment I am familiar with. I have also had the opportunity to assist my preceptor in performing assessments of this type and can attest to how this format can provide quite a bit of information regarding the client and their overall status. The authors break down the geriatric assessment into the following points: fall risk, hearing and visual decline, incontinence, nutrition, medications, activities of daily living (including instrumentals), cognitive status, depression, support from others, finances, and personal beliefs. This is a quick guide that can help us interview patients efficiently since time constraints are often the norm in the clinic setting. Any deviation from the aforementioned points would obviously require further assessment into those specific areas. The Mini-Mental State Exam (MMSE) is the test most often used in my practicum site to assess cognition.
It would be useful to have a variety of assessment tools and methods available depending on the geriatric client’s needs. Wiltjer and Kendall (2011) describe different approaches to assessing older patients to help us tailor our interviews to their circumstances by focusing on small clusters of symptoms and factors. They suggest focusing on the geriatric Ms which are mobility, mind, multi-complexity, medications, and ‘matters most to me’. Another tactic is the three Ds which are depression, delirium, and dementia. A more physical approach to geriatric assessment is similar to what I mentioned in the previous paragraph which includes intellectual impairment, instability, incontinence, vision and hearing loss, sarcopenia, and frailty. A shorter way of assessing for these factors narrows them down to multimorbidity, frailty, and disability (Wiltjer & Kendall, 2011).
**Attached is a form I have used during initial geriatric assessments during previous academic experiences that has helped me touch on the most important points to guide my approach**
Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277
Ward, K. T., Hess, M., & Wu, S. (2019). Geriatric Assessment in Multicultural Immigrant Populations. Geriatrics (Basel, Switzerland), 4(3), 40. https://doi.org/10.3390/geriatrics4030040
Wiltjer, H., Kendall, N. (2019). Assessment of older people 1: defin
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