COMPREHENSIVE

GERIATRIC ASSESSMENT
 WELLNESS MODEL A. McGrory, 1978

Disequilibrium
}
Negative Outcomes
Equilibrium Safety
Positive Outcomes
}
Disequilibrium
Negative Outcomes
}
= Individual = Risk Factors = Interventions
• A multidimensional process designed to
assess an elderly person's functional
ability, physical health, cognitive and
mental health, and socioenvironmental
situation.
Why a Specialized
Assessment?
Traditional
Assessments are
focused on
determining a
“Medical Diagnosis”
Closer to a Functional
Assessment
Focused on the
measurement of a
person’s ability
to fulfill
responsibilities and
perform tasks for self
care
 Gerontologists Recognized
• The importance of identifying functional
impairments as early manifestations of
active illness in older people. (Besdine, 1983)
• The importance of assisting the P/F in
maintaining the greatest degree of
functional independence possible (Williams, 1983)
1st used in the 1920’s to determine
disability in worker’s comp. claims.
1950’s…1st time the assessment used for

geriatric population by a few physicians

1980’s…widely accepted
1987…Development of the Minimum Data
Set (MDS) & the Resident Assessment
Instrument (RSI) and Federally mandated to
be used by all Medicare/Medicaid Facilities
Expanded to Include:
• Everyday competence which evaluates a
person’s ability to:
– Perform tasks in addition to daily behaviors
such as managing finances
– Coordinate physical, cognitive, emotional
and social functioning
Strong emphasis on
sensitivity to cultural
and contextual
factors that affect
behavior
Tools Developed Include the:
Activities of Daily Living (ADL) &
Instrumental Activities of Daily
Living (IADL)
Example of a Tool:
Miller pps. 94-111
Note: Additional
columns added for
ongoing assessment
Class Exercise
 STUDENT Age Related Changes: Risk Factors (RF) STUDENT Age Related Changes: Risk Factors (RF)
FINDINGS (ARC) ie: what Related to: FINDINGS (ARC) ie: what Related to:
Per changes are expected 1.Collaborative Per changes are expected 1.Collaborative Problems
Body System connected to the Problems Body System connected to the Principle Diagnosis
findings Principle Diagnosis findings Co-morbid Conditions
Co-morbid Conditions Lifestyle Factors
Lifestyle Factors
Musculoskeletal Genitourinary

ADL Score____
Psychological/
Social

IADL Score______
What is going well for the Client/Family(Caregivers)? What are their Strengths?
CLINICAL PREPARATION
GUIDE
 NURSING 406  WEEKLY PLAN OF CARE

This tool is an amalgamation of the traditional care plan and the functional
model care plan.
Each week you will complete this format PLUS:
The Older Adult Oriented Physical Assessment (one time unless instructed by your
clinical faculty).
AND
The Medication Sheet (if assigned by your clinical faculty).
Clinical Evaluation Tool
These will be turned in to your clinical instructor each week by Thursday
at 1230 in order to be eligible to attend clinical the following week.
 NURSING 406  WEEKLY PLAN OF CARE
Reason for Needing Health Care including: Collaborative Problems (Principle Diagnosis, Co-
morbid conditions) Lifestyle Factors and Environmental Factors ( lives alone, lives with
family, living conditions) AND how they manifest themselves in this client: Include the client’s
age & Code Status.

Polypharmacy: Look up and write up (on the medication sheets) each medication this older adult is
taking. Then summarize, in the space below, what side effects you observe and if they are harmful. If
there is no evidence of current side effects from polypharmacy; what you will monitor this client for
that he or she may be at risk for developing in the future. Make recommendations (for this exercise
only not to the staff or physician). The following website may be helpful:
http://www.drugs.com/drug_interactions.php (Include medication sheets in the packet)
Geriatric Syndrome
Derived from a Negative Functional
Consequence

Related to:
State if related to an age-related
change (ARC) or a risk Factor (RF)
NOTE: Risk factors are either Collab.
Problems or Lifestyle Factors

AEB or Potential Complication

Interventions

Rationale
Site source—can be expert opinion, if
so, note last name of expert ie:
Expert opinion Jones, RN, ‘07

Positive Outcomes
“AS EVIDENCED BY”
(What did you do/assist
with/observe that was done to
achieve positive outcome?)
Geriatric Syndrome Pressure Ulcers
Derived from a Negative Functional Consequence

Related to: Imbalanced nutrition: less than body requirements d/t:

State if related to an age-related change (ARC) or a risk Factor delayed wound healing (ARC)
(RF) NOTE: Risk factors are either Collab. Problems or loss of subcutaneous fat (ARC)
Lifestyle Factors loss of appetite 2° Cancer dx. (RF)
Limited mobility/Bedfast d/t:cancer related weakness and fatigue (RF)

AEB or Potential Complication Reddened Painful Coccyx (Stage I)

Interventions Turn and position every two hours

Utilize turning sheet
Utilize pressure relieving mattress
Apply lotion and message well into skin
Encourage protein food/fluids as tolerated
Rationale Promote optimal circulation
Site source—can be expert opinion note last name of expert ie: Prevent shearing forces
Expert opinion Jones ‘07 Reduce pressure and promote capillary circulation
Prevent drying and cracking of skin
Intake appropriate only if providing comfortand easily tolerated.

Positive Outcomes Reddened areas diminished in color during shift

“AS EVIDENCED BY” Pt. report decrease in pain at site of boney prominences
(What did you do/assist with/observe that was done to Skin remains supple. No evidence of cracking (port of entry for bacteria).
achieve positive outcome?)
Describe the challenges this Organization meets as a whole as it carries out its
Mission Statement concening the care for the older adult population. What is the
Mission Statement? What barriers does the Agency encounter?

Summarize your impression of this client’s progress toward outcomes. In situations

where you won’t see this client again, it is reasonable to give your “best guess” based on your
findings to date,(ie: “Based on the findings as listed above, this clinician’s belief is that…”).

Journal Entry: Summarize your impression of this week’s experience. What

course/personal objective did you work toward this week?