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1.
Physical,
psychological,
and
socioeconomic factors interact in complex
Old age is not synonymous to disease. ways to influence the health and
functional status of the older person.
It is a developmental process.
to specific diseases.
conditions.
Cultural influences.
Family influences.
Socioeconomic
and
environmental
factors.
Assessment
can
challenging to nurses
be
lengthy
Laboratory findings
Medical Diagnosis
Nursing Diagnosis
the physical
fatigue.
assessment
Provide
fatigue
to
comfortable
avoid
room
ample
space
to
supportive devices.
accommodate
Functional
status
of
the
older
Geriatric Assessment is a
multidimensional interdisciplinary
diagnostic process intended to
determine a frail elderly persons
medical,
psychosocial,
and
functional
capabilities
and
problems in order to develop an
overall plan for treatment and long
term follow up.
Extends
beyond
the
Components:
Standard
medical
history
and PE
systematic
Improve
process
of
care-
diagnostic accuracy
of life
search
for
specific
conditions that are common
among older person
use
Arrange
management
long-term
case
Cost of care
Goal
Highest priority:
Prevention
performance
of
Screen
for
preventable
diseases
Screen
for
functional
Components of CGA
1. Medical Assessment
problem list
nutritional status
of decline in the
independent
ADLs
Drives
medication review
2. Assessment of Functioning
Basic ADL
IADL
AADL
development
and
3. Psychological Assessment
Mental
status
Cognitive
procedures
necessary.
testing
include labs
most
and ancillary
that
beneficial
to
are
frail
elderly
medical,psychological,functi
onal, nutritional problem
(chronic
illness,dementia,depression,
disabilities and malnutrition)
4. Social Assessment
financial assessment
5.
Assessment
home safety
transportation
Environmental
Immobility
Instability
memory
Iatrogenic disorders
Impaction / Incontinence
Outcome
Screening
or
targeting
of
appropriate patients
Assessment
(impaired vision/hearing)
of
recommendations,
including
physician and patient adherence
with recommendations.
(intellectual)
Implementation
and
development of recommendations
chronological age
functional disability
physical illness
to
Core
team:
doctors,
nurse,SW,
Nutritionist,PT/OT,Pharmacist,
Psychiatrist,Audiologist
psychosocial conditions
Exclusion Criteria
terminal illness
severe dementia
CGA Approach
Data gathering
Implementation
Monitoring response
Revision
F- Fluids
A- Aeration
N- Nutrition
C- Communication
A- Activity
P- Pain
E- Elimination
S- Socialization
Geriatric Assessment
Demographic Data
Dementia or delirium
End-of-life care
Barthels Index
(MMSE)
Malnutrition
Pressure ulcers
Urinary incontinence
ASSESSMENT TOOLS
Geriatric Assessment Tools
are
standardized
means
of
Living
Portable
Mental
Questionnaire (SPMSQ)
Short
Status
Assessment
Scale
for
Instrumental
Mnemonics
SCUM
or
SHAFT
(MAST)
Tools
for
Functional
Assessment
Functional Independence
Measure
Barthels Index
Mini-Mental
State
Examination (MMSE):
FINDINGS:
Short
Portable
Mental
Question Response
o
o
to
very
low
scores
correlate
moderate
errors:
severe
cognitive
cognitive
Scale:
Michigan
Alcoholism
Cognitive Function
SOCIAL ASSESSMENT
Should include availability of help in
case of emergency.
o
o
Advanced directives.
capabilities
for
dealing
constructively with a stressful
events.
Economic status.
Living arrangements
Nutrition
10
19
seconds
is
Sexual activity
Recreational activity
Security
Injury Risk
Review of Systems
MOBILITY
AND
BALANCE
ASSESSEMENT FOR FALLS
20 29 seconds variable
mobility.
balance
RISK
Introduction
Health
Delivery
System
Social Security
Mandatory
Fewer
participation
through
payroll contributions
benefits
than
many
industrialized nations
other
Medicare
Medicare (contd)
Inpatient care
Part C:
Hospice care
Home health
Part
B:
Supplemental
medical
insurance
Lab
Home health
Doctor visits
Some outpatient therapies
Mental health services
Outpatient hospital services
Assistive Devices
Some
chemotx)
Part D:
Long-Term Care
Home Care
Assisted Living
Medicaid
Financed
government
Kalusugang Pangkalahatan
by
state
and
federal
Health
LTC
for
older
Americans
and
Supplemental
LTC
insurance
available
expensive
Acute Care
but
very
Approach:
General
promotion.
Protection
specific illnesses.
PCB1
Enhance
incentives
for
Ensure
complete
and
timely
Puericulture centers
PCB 1 inclusion
Tertiary
Secondary
Primary
Primary Care
OF HEALTH CARE
PCB
providers
health
against
Private clinics,;
Community
hospitals
and
health
technological
Secondary Care
Health Care Settings
Goal: To alleviate disease
prevent further disability.
and
Hospital Schools
Industrial Clinics
Smaller,
non-departmentalized
hospitals including
regional hospitals.
Services
offered
emergency
to
patients
and
with
and
centers
Highly
Tertiary Care
Approach:Restorative
and
rehabilitative activities to attain
optimal level of functioning.
Extended-care facilities
Nursing Facility
Hospices
Nursing Center
Out-patient settings
Physician (MD)
Nursing Home :
= is the dominant setting in which
long term care is provided for people
who require regular or continuous
skilled nursing care.
Other Names:
Resisting
to
stereotype
patients
Environment management
elderly management.
Stroke
system anymore.
the
Chemotherapy
Surgeries
Other acute conditions
Community-Based Services
to
manage,
less
smaller, easier
expensive.
not
Goals:
It
provides
It
is
care
ill
and
services
persons
special
kind
and
of
to
their
medically
GOAL of Hospice: To
comfort care NOT cure.
provide
WHY Hospice?
Hospice
terminally
families.
that
do
not
Achievement
of
the
best
possible
normal process.
distressing symptoms
o
o
o
o
(subtle
changes=
understanding
of
rehabilitation principles.
Communication
Senses and Communication
o
o
care
outside
the
of
called- resident.
continuum
hospital.
impending
serious problems).
Keen
Pitch high/low
Timber quality
Cataracts
trigger feelings
environment, nonverbal
communication
Glaucoma
Macular Degeneration
eye in 5 years
Diabetic Retinopathy
Special Considerations:
medications or poisons
Blindness
doing them.
Deafness
deaf.
If patient is wearing a
lip-read.
their arm.
obstacles.
buzzing, or roaring
Note writing.
Expressive: unable to
Receptive: unable to
comprehend
produce language
Aphasia
Pointing
Hand gestures
Drawings
Avoid distractions
Sadness
Depression
in sleep
Psychomotor agitation or
sentences
retardation
Fatigue
Feelings of worthlessness or
inappropriate guilt
concentrate
instructions
pictures
Communication Tips
Summary
Communication in Healthcare
Instrumental communication:
necessary behavior for assessing
and solving problems
Therapeutic Communication
An exchange of information
(Satir, 1976):
Hearing aids
Picture boards
Synthesized
(computer-generated) and
digitalized (recorded) speech
o Maximize communication: