Comprehensive Geriatric Assessment Overview

NCM 114 A- CARE OF OLDER ADULT

| MARK DARYL A. MISUARI | CLINICAL INSTRUCTOR: JOEL ARVIN GALLEGO | SEM 1 | A.Y. 2022 – 2023 |

SOCIAL ASSESSMENT Examples of questions recommended for use in a

brief assessment include:
It includes collecting information on the presence
of a social network and interaction between the
older adult, friends, neighbors and community as
a whole.
Spiritual ASSESSMENT
Religiosity
strong religious feeling or belief
Believing in God, organized rituals
I was wondering how important spirituality or
religion is to you?
Do you attend a faith community or belong to
some other type of religious or spiritual group?
Are there any particular spiritual beliefs practices
you find especially helpful in dealing with
challenges?
How your spirituality was shaped your
understanding to your current situation?

Spirituality PROBLEMS RELATED TO THE OLDER PERSONS

Ideas of belief that encompasses personal
philosophy and understanding of meaning and 1. Physiologic Functioning
purpose in life. 2. Behavioral
Anxiety
Spiritual support/ASSESSMENT Depression
Polypharmacy
Spirituality is also an important source of inner 3. Safety
strength. When appropriate, encouraging Fall
patients to engage in spiritual practices such as  Need to evaluate the gait, balance, and
prayer, scripture reading, meditation, worship muscle strength
music can enhance wellness, coping, and
recovery.
NEEDS for self-care and life support and Is a long term care solution for older adults living
health maintenance with memory loss, including Alzheimer’s and other
forms of dementia.
Levels of care to older people
Alzheimer’s disease is thought to be caused by
Independent Living abnormal build-up of proteins in and around brain
Assisted Living cells. One of the proteins involved is called amyloid,
Memory Care deposits of which forms plaques around brain cells.
Affordable Housing The other protein is called tau, which deposits of
Skilled Nursing which form tangles within brain cells.
Short Term Care
5 A’s of Alzheimer’s diseAse
INDEPENDENT LIVING
1. Amnesia- refers to the loss of memories, including
Is simply any housing arrangement that is facts, information and experiences.
designed exclusive for older adults. The house is
supposedly friendlier to aging adults with easier 2. Apraxia- is a neurological disorder characterized
navigation and no maintenance to worry about. by loss of the ability to execute or carry out skilled
movements and gestures, despite having the desire
ASSISTED LIVING and the physical ability to perform them.

Is designed for seniors who value their
independence. But they already need some
assistance when it comes to ADL.
Memory CARE
3. Agnosia- is a rare disorder characterized by an
inability to recognize and identify objects or persons.
4. Anomia- is defined as a language specific
disturbance arising after brain damage whose main
symptom is the inability of retrieving known words.
5. Aphasia- is a language disorder caused by
damage in a specific area of the brain that controls
language expression and comprehension.
The Hippocampus is one of the brain areas affected
by the Alzheimer’s disease. In the early stages of AD,
the hippocampus shows rapid loss of its tissue, which
is associated with the functional disconnection with
other parts of the brain.
Affordable housing
This refers to nursing homes
Almost all nursing homes provide long-term care
services to some degree, and many nursing
homes also provide additional community-based
services.
Skilled nursing
Nursing homes are where people usually go
when they require high level of assistance.
Skilled nursing is a level of care that is already
appropriate for the provision of skilled
rehabilitative therapies or medical care in cases
such as recovering from stroke.
Short term care
Is a temporary medical aftercare after surgery,
injury, illness or other medical condition that is
expected to improve
Services is typically last several weeks or a few
months
Principles in the care of older people
Wellness
Health Promotion
Recovery and Rehabilitation
Quality of Life
Wellness
An act of practicing healthy habits on a daily
basis to attain better physical and mental health
Physical Dimension of Wellness
Need for regular physical activity
Discouraging the use of tobacco, drugs, and
excessive alcohol consumption
Good physical wellness combination of good
exercise and eating habits
Health Promotion
The process of enabling people to increase
control over their health and its determinants and
thereby improve their health.
Primary Prevention
Are those designed to completely prevent a
disease from occurring such as immunization
against pneumonia, influenza.
Secondary Prevention
Efforts are directed toward early detection and
management of disease such as the use of
colonoscopy to detect small cancerous polyps or
they have to have annual check-up.
Example:
Colon and Rectum:
Age 50
Sigmoidoscopy- Q5 years
Colonoscopy- Q10 years
PSA- Prostate-Specific Antigen Test
High levels of PSA may be caused by:
Prostate Cancer
BPH (Benign Prostatic Hyperplasia)
Normal value: <0.04 ng/dl
Abnormal value: >0.04ng/dl
Digital Rectal Exam
Position:
Bend over
Side lying
Tertiary Prevention
Are the efforts used to manage clinical diseases
in order to prevent them from progressing or to
avoid complications of the disease
Recovery and Rehabilitation
A return to a normal condition.
Is a treatment or line of treatments designed to
facilitate the process of recovery from injury,
illness or disease to as normal a condition as
possible.
Factors influence the rehabilitation potential of the
geriatric population
Coping Strategies
Spiritual well-being
 Positive social support Intellectual
Self-efficacy Emotional
Self-belief Social
Spiritual
Quality of Life Occupational
The standard of health, comfort and happiness
experienced by the older adults.
As people age, their quality of life is dependent
upon their ability to maintain autonomy and
independence.

Quality of Life Model

Quality of Life Physical well-being

Psychosocial well-being

Spiritual well-being

Social well-being
Physical Wellness
Six Dimensions of Wellness
This is the first form of the six dimensions because
Developed by Bill Hettler, co-founder and President without physical wellness, it’s difficult to enjoy
of the Board of Directors of the National Wellness anything else. Eating right, getting enough
Institute proposed that wellness are composed of six exercise, and keeping up with your hygiene
dimensions: rituals are all important parts of maintaining your
Physical physical wellness.

Intellectual Wellness
Intellectual wellness is a measure of sanity.
Someone with a very pleasant lifestyle may still
be unhappy if they’re not getting enough
intellectual activity, like engaging conversation,
Spiritual Wellness
interesting books to read, or problems to solve.
Emotional Wellness
Same people have trouble with emotional
wellness due to an internal imbalance, while
others have an easy time being satisfied almost
anywhere. To maintain emotional wellness,
keeping a journal and talking your feelings out
with a friend are the best way to figure out how
you feel and make plans to feel better.
Occupational Wellness
Social Wellness
Is how happy we are interacting with others. As
everyone has different personal preferences for
number of friends, and amount of time spent
alone versus with company.
Introverts may be socially well with one or two
close friends they see a few times a week, while
socialites may have trouble staying socially
satisfied without actively talking to at least thirty
people a week. You can also be conflicted on
social wellness, happy with your day to day but
missing a particular person or type of interaction
that is currently unavailable.
Spiritual wellness is our final category because in
a way, it gathers up the ‘everything else’. This is
often measured by whether or not you feel you
have a purpose in life, are happy in your current
circumstances, and are happy with your general
life outlook. You don’t have to be religious to
have spiritual wellness, just be at peace with
yourself and your surroundings.
We’ve all known at least one person who can’t
be happy without something to do. These
constantly busy individuals have a high need for
occupational wellness. They love to work and
feel satisfied in life when they have good work to
do. Of course, occupational wellness can also
translate to financial concern. Even for those who
aren’t primarily motivated by work, feeling secure
 about your finances is a good sign of - Exercises that are within the capability of the
occupational and financial well-being. older adults such as a take a short walks

The benefits of improved whole-person 3. Stress Management

wellness for older adults
- Stress may be defined as any event that places a
Longer and healthier life demand on the body, mentally and physically.
Active social interaction Exercises and good nutrition are factors also that
Mental and emotional health help reduce stress in older adults.
Active part of the workforce
Financial independence - Deep breathing exercises, talk about the
concerns of our lolo and lola or ask what triggers
Nursing intervention for specific their stress.
problems of the older person
B. Physiologic Functioning
A. Wellness
Activity and Exercise
Nutrition and Support
1. Nutrition Support
Respiratory Management
Tissue Perfusion and Management
- Nutrition is one of the major determinants of
Electrolytes and Acid-Base Balance
successful aging. If that older adult is having a
Skin Wound Management
good nutrition then he/she has a successful
Promotion of Physical Comfort
aging.

C. Behavioral
2. Activity and Exercise

Coping Assistance
 Patient Education
Spiritual Care
Coping Assistance
Need to let them understand the changes that is
happening to them;
And it would be explained that it is not only
happening to them;
Advise them to focus on the things they are
grateful for, but at the same time we have to
allow them to express their feelings and
acknowledge them.
Patient Education
It is the practice of informing patients about their
health, wellness, treatment plans, potential
outcomes, and other information critical to the
patient experience.
Spiritual Care
It is an aspect of health care that supports the
inner person (spirit/soul) to help deal with the
health challenges that you or your loved one is
facing.
D. Safety
1. Management of the Environment
Physical environment that are safe can make the
difference between the independence and
dependence for all individuals but are of
particular importance for older adults.
Hazards in the physical environment can lead to
painful or debilitating injuries among older
people. Injuries from fall, fire and traffic collisions
are the most common accidents.
2. Risk Reduction Activities
Household hazard that increase the risk of falling
need to be removed. If possible, handrails in the
comfort room or anywhere in the house should
be added. Basically, we have to assess and
identify the hazard and risk that are present then
correct them right away to prevent accidents.
E. Bio-Ethical Component of Care
Autonomy
 is the concept that each person has a right to
make independent choices and decisions.
Beneficence/Nonmaleficence
This is the concept of doing good which is
beneficence and doing no harm the
nonmaleficence are integral to healthcare.
Nurses intent to do good for their patients. To be
concerned about situation that can result in
harm to patients.
Justice
Refers to the fairness of an act or situation. This is
the principle that will tell us that all individuals
regarding of a race, should have equal
opportunity and access to care.
Quality and Sanctity of Life
Sanctity of life supports the belief that all life is of
value and that is value is not based on how
functional or effective person’s life is.
Communication Considerations
Demonstrate respect by remembering names
and calling the client he/she prefers being
addressed (instead of grandma or grandpa)
Face the client when speaking.
Speak distinctly, clearly using normal tone of
voice. DO NOT SHOUT.
Increased frequency of voice pitch makes
hearing difficult.
Provide written instructions or repeat instructions.
Memory and attention span is diminished.
Promoting Independence and Self-Esteem
Place equipment conveniently and encourage
the use of self.
Encourage the client to do as much as possible
for himself/herself, provided that safety is
maintained.
Assist the client’s ability to think, reason and
make gestures.
Promoting Hygiene and Skin Care
Daily bath is not necessary for the client.
Use mild, supper flatted soap.
Use bath oils, lanolin or body lotion to protect the
skin.
 Use protective devices such as sheepskins,
pads/mattress.
Change position frequently. Loss of
subcutaneous supporting tissues makes the skin
sensitive to pressures.
Massage bony prominences.
Assist in ambulation as much as possible.
Soak feet in warm water before cutting the nails.
Care of Visual Aids and Dentures
Keep eyeglasses clean and always available.
Keep right lights on to prevent accident.
Clean dentures following each meal.
Promotion of Exercise and Good Body Alignment
Regular exercises of feet and legs to prevent
peripheral vascular disorders
Encourage correct posture and deep breathing
Promote proper body alignment
Use supportive pillows and firm mattresses
Use footboard
ROM Exercises
Practice gradual change of position
Provide well-fitting shoes
Regulation of Body Temperature
The normal body temperature of elderly client is
below 37 degrees Celsius.
Body temperature of 99 degrees Fahrenheit
indicate presence of infection usually respiratory
or bladder infection
Normal Temperature for Elderly
 97.8 to 99 degrees Fahrenheit
Provide adequately warmth to the client
especially during cold climate.
Promotion of Sleep Pattern
The elderly clients sleep tightly, intermittently with
frequent waking. Provide low bed, right light and
adequate supervision when getting up to
prevent falls.
Limit fluid intake before going to bed to prevent
sleep pattern disturbance for frequent urination
during at night.
Promote comfort and relaxation.
Create restful environment.
Attend to bedtime rituals.
Promote regular sleeping and waking hours.
Provide a glass of milk of bedtime.
Avoid caffeine and alcohol in the evening.
 Go to bed only when sleepy.
Promotion of Nutritional Needs
Increase fiber in the diet
Provide vitamin and mineral supplements
Provide skim milk
Increase protein in diet but reduce calories
Promotion of Urinary Elimination
Frequency of voiding is common. This is due to
decreased muscle tone of the bladder
Increase fluid intake to dilute the urine
Many elderly men have BPH. The client should be
assessed for signs and symptoms of BPH
Sexuality
The elderly is still capable of sexual arousal and
orgasm
Provision for Emotional Needs
The elderly needs someone to talk to. Plan time
to visit
The client is often times comforted by touch.
Touch conveys feelings of concern, intent and
acceptance
Maintain family contact
Provide diversional activities
Allow client to verbalize feelings of death. Do not
avoid the topic
Common problems among the elderly
Confusion/Dementia
A chronic disturbance involving cognitive
deficits including memory impairment
NURSING INTERVENTIONS:
Spend time with the client
Use touch to convey concern
Provide frequent reiteration of orienting date)
time and place)
Have clocks or calendars in the environment
Explain all actions, procedures and routines to
the client
Address the client by his/her name
Keep a routine of activities
Postural Hypotension Financial Abuse
 Such as taking their money or forcing them
Lowering BP by 15 mmHg (systolic) or 5mmHg to sign over their assets
(diastolic)
Community resources for care of older
NURSING INTERVENTIONS: persons

Get out of bed slowly

Community Resources
Sleep with HOB elevated several inches
Have a daily fluid intake of 2-3 liters
Caregiver associations and support groups
Avoid hot showers or hot baths. This may
Hospice and Palliative Care Programs
cause venous dilatation and thereby venous
Disease-specific support groups and
pooling
associations
Avoid bending down and suddenly standing
Community Health Ethics
up again
Geriatric Case Management
Rest for 60 minutes after meals
Avoid prolonged standing
Goals of Community Resources

Elder Abuse
Providing Quality Health and Long-Term Care
Ensuring Enabling and Supportive
There are many types of abuse used against the
Environments
elderly:

Challenges: Issues and Gaps

Psychologic Abuse
 Such as instilling fear, threatening
Rising number of senior citizens who are
Physical Abuse
victims of violence and abandonment
 Such as hitting, slapping, or burning
 Noncompliance of some residential building
and establishment in terms of making their
facilities accessible to senior citizens.
Criteria for Evaluation
Indicators for Wellness
Physical wellness
Psychological/emotional wellness
Social wellness
Intellectual wellness
Spiritual wellness
Environmental wellness
Economic wellness
Cultural wellness
Climate wellness
Governance and social justice wellness
Responses to Care
Standards and Criteria of Gerontological Nursing
Standard 1 – Uniqueness of Older People
Standard 2 – Functional Ability and Independence
Standard 3 – Mastery of the Environment
A sense of mastery over the environment (or
life situation) is essential for older persons.
Standard 4 - Gerontological Nursing Knowledge
Gerontological nursing practice is derived
from a specific and evolving body of
knowledge pertaining to older persons.
Standard 5 – Sustaining Interpersonal Relationships
The development of sustaining interpersonal
relationships facilitates older persons to cope
with their health care experiences
Standard 6 - Advocacy
Gerontological nurses should advocate with
older persons to protect their rights and
responsibilities
Ethical Aspects in the Care of Older Persons
What is Ethics?
 It is our moral principle that governs our
behavior or what we consider before we
conduct certain activity
Nursing Ethics
Concerned with moral principles that govern
the conduct of a nurse in his/her relationship
with patient’s physicians, colleagues, the
nursing profession, and the community or
public
What Principles Make Actions Morally Right?
Advocacy
Refers to loyalty a championing of the needs
and interests of others requiring the nurse to
educate their patients and their families so
that they know their right are fully informed,
and that they are able to access all the
benefits they are entitled to
Autonomy
Concept that person has a right
Beneficence/Nonmaleficence
Doing good and doing no harm
Confidentiality
Confidentiality is the code of ethics
emphasized respect for human dignity which
can be demonstrated in daily for work and
this includes respect for privacy and
maintaining confidentiality
Fidelity
Refers to keeping promises or being the true
to another; being faithful to commitments and
responsibilities. Fidelity is particularly important
in the care of geriatric patient because of the
amount of trust our lolo and lola put in the
health care system
Justice
Fairness
Quality of Life
 The right to life Conduct assessments
Develop care plans that address pertinent
Reciprocity problems
Arrange, interview for and monitor in-home
Concerned with the ability to be true to one’s caregivers or other services
self while respecting and supporting the Act as a consultant for caregivers
values and views of another Review financial, health-related, legal issues
Provide referrals to other geriatric specialists
Veracity Intervene in times of crisis
Act as an advocate and/or liaison between
Means truthfulness families and service providers
Keep the family informed of any problems
Current Trends and Issues in the Care of the Older Coordinate or oversee care
Person Assist with transitions in living arrangements
Provide education and links to resources
Offer counseling and support
Ethical Aspects in the Care of Older Persons
Some PGCMs offer guardianship and
caregiving
Geriatric Care Management

Hospice-Palliative Care
Professional Geriatric Care Manager (PGCM)
is a specialist who helps families care for other
Hospice Care
adults while encouraging as much
independence as possible
- it is a way of caring for the terminally ill and their
families. It aids in putting quality and meaning
Professional Geriatric Care Manager (PGCM) may
into the remaining period of life.
perform the following services:
- Focuses on the care, comfort and quality of life
of a person w/ a serious illness who is
approaching the end of life.
Primary Goals of Hospice Care
Provide comfort
Relieve physical, emotional, and spiritual suffering
Promote the dignity of terminally ill persons
Hospice Philosophy
- Emphasizes the belief that patients should be as
possible during the later days of their illness.
- It is the interdisciplinary team approach that
looks for solutions to the patient’s medical,
psychosocial, and spiritual problems and helps
the patient die with dignity.
Pain relief
Symptom control
Coordinate home care and institutional care
Follow-up and counselling
Palliative Care
- Palliative Care is an approach that improves
quality of life of patients and their families feeling
the problems associated with life-threatening
illness through prevention and relief of suffering
by means of early identification and impeccable
assessment and treatment of pain and other
problems, physical, psychological and spiritual.
(WHO, 2002)
- Is a specialized medical care that focuses on
providing patients with relief of pain.
Principles of Palliative Care
Provides relief from pain and other distressing
symptoms.
Affirms life and regards dying as a normal
process.
Intends neither to hasten nor postpone death.
Integrates the psychological and spiritual aspects
of patient care.
Offers a support system to help patients to live as
actively as possible until death.
Offers a support system to help the family cope
during the patient’s illness and in their own
bereavement.
Support System During Patient’s Illness
- Nurses help patient adhere to their medication
Safe and effective care environment schedules and protocols while still maintaining a
Health promotion and maintenance direct line of communication between the
Psychosocial integrity patient and the attending physician, managing
Physiological integrity equipment.

Essential Components of Palliative Care Advocate

Effective symptoms control - The nurse will work on behalf of the patients to
Effective communication with patient and maintain quality of care and protect the
families patient’s rights. Nurses will intervene when there is
Rehabilitation to maximize independence a care concern, and work to resolve any patient
Continuity of care and coordination between care issues.
services
Terminal care Counselor
Support in bereavement
Education and research - An active listener. Listening and understanding
their concern is a big help already to the patient.
Nurses’ Role in Palliative Care
Collaborative role
Direct Care
Advocate - Adequate collaboration and information
Counselor exchange between health care professionals is
Collaborative role necessary to ensure continuity, efficiency and
safety of care.
Direct Care
Issues and Trends in Palliative Care

DNR- Do not Resuscitate (DNR)

- Usually written by a doctor or per request by the

patient. It instructs health care providers or nurses
NOT to provide or do cardiopulmonary
resuscitation (CPR) if a patient’s breathing stops if
the patient’s heart stops beating.

Active Euthanasia

- Is a killing a patient by active means for example:

Injecting a patient with a lethal dose of a drug