NCM 114: UNIT 1

COMPREHENSIVE ASSESSMENT
NOLIE ROY E. BICLAR, R.N., M.N.
COMPREHENSIVE ASSESSMENT
A Comprehensive geriatric assessment (CGA) is
a process used by healthcare practitioners to
assess the status of people who are frail and older
in order to optimize their subsequent management.
It is also designed to evaluate an older an older
person’s functional ability, physical health,
cognition and mental health and socio-
environmental circumstances.
 EYES AND VISION
 Eyelids baggy and wrinkled, eyes deeper in sockets,
conjunctiva thinner and yellow.
Quantity of tears decreases, Iris fades Pupils smaller,
let in less light Night and depth vision less Floaters”
can appear, lens enlarges.
Both cornea and lens undergo predictable changes.
The lens become opaque thicker and more opaque
resulting in blurry vision, night vision issues and
sensitivity to glare.
 EARS AND HEARING LOSS
Irreversible, sensor neural loss with age, men
more affected than women.
 Loss occurs in higher range of sound by 60
years, most adults have trouble hearing above
4000Hz Normal speech 500-2000H.
 RESPIRATORY SYSTEM
Lungs become more rigid, pulmonary function
decreases, number and size of alveoli decreases,
vital capacity declines, reduction in respiratory
fluid, bony, changes in chest cavity, decreased
cough efficiency, reduced ciliary activity,
vulnerable to respiratory infections.
 CARDIOVASCULAR SYSTEM
Heart smaller and less elastic by the age of 70,
cardiac output is reduced to 70%, heart valves
become sclerotic & tortuous, heart muscle more
irritable & arteries lose their elasticity, more
arrhythmias, arteries more rigid and veins dilate.
 GASTROINTESTINAL SYSTEM
 Reduced GI secretions, reduced GI motility,
decreased weight of liver, reduced regenerative
capacity of liver and metabolizes less efficiently.
 In old age, the rate of gastric secretion decreases
and incidence of peptic ulcer and gastritis
increases. These gastric problems in adult may be
a result of Helicobacter pylori, drug ingestion or
genetically programmed changes that may occur
in old age.
 EXCRETORY SYSTEM
 The kidneys of older adults have
more difficult time responding to any
added metabolic stressor on the
body when nephron becomes less
efficient and fewer in numbers. Like
other the other organs, older kidneys
work well under normal conditions
but have reduced tolerance for
disease, whether originating from
the kidneys themselves or from
other organs. This is why older
adults are more likely to experience
acute or chronic renal failure than
younger individual.
 MUSCULOSKELETAL SYSTEM
 Musculoskeletal dysfunction is a major cause of
disability in older adults altering mobility, fine motor
control, and the mechanics of respiration. It occurs as a
result of a decline in muscle mass ( sarcopenia ), which
causes overall strength to deteriorate. Other changes
that take place within musculoskeletal system include
decreased reflexes, loss of cartilage and thinning of the
vertebrae, decrease calcium absorption, joint cartilage
deterioration and deterioration of extrapyramidal system.
 MUSCULOSKELETAL SYSTEM
 As people age, their joints are affected by changes in cartilage
and in connective tissue. The cartilage inside a joint becomes
thinner, and components of the cartilage (the proteoglycans—
substances that help provide the cartilage's resilience) become
altered, which may make the joint less resilient and more
susceptible to damage. Thus, in some people, the surfaces of
the joint do not slide as well over each other as they used to.
This process may lead to osteoarthritis. Additionally, joints
become stiffer because the connective tissue within ligaments
and tendons becomes more rigid and brittle. This change also
limits the range of motion of joints.
 NERVOUS SYSTEM
• The nervous system in older adult loses nerve cell mass and
shows some brain atrophy. Nerve cells and dendrites decline
in number, which allows transformation, shortens reaction
times and weakens reflexes. Brain weight is said to decrease
with age, but this does not seem to interfere with individual
thought process.
 NERVOUS SYSTEM
•  As one ages there is a loss of up to 10,000 nerve cells a day.
While there is a loss of all cell types in the body as part of the
aging process, nerve cells do not reproduce so the lost cells are
not replaced. The loss of nerve cells results in a decreases in
the function of the nervous system. The exact function lost is
depended on the individual and the exact cells lost. As there
are many more nerve cells than are necessary for the proper
functioning of the nervous system, it is unlikely that routine
loss of nerve cells causes any apparent problems until
advanced old age.
 ENDOCRINE SYSTEM
 As the body ages, changes occur
that affect the endocrine system,
sometimes altering the production,
secretion, and catabolism of
hormones. For example, the
structure of the anterior pituitary
gland changes as vascularization
decreases and the connective tissue
content increases with increasing
age.
 ENDOCRINE SYSTEM
 This restructuring affects the gland’s
hormone production. For example,
the amount of human growth
hormone that is produced declines
with age, resulting in the reduced
muscle mass commonly observed in
the elderly.
 The adrenal glands also undergo
changes as the body ages; as
fibrous tissue increases, the
production of cortisol and
aldosterone decreases.
 ENDOCRINE SYSTEM
 Interestingly, the production and
secretion of epinephrine and
norepinephrine remain normal
throughout the aging process.
 IMMUNE SYSTEM
 The age related decline of immune system
functioning gives arises to three general
categories of illness that preferentially afflict older
adults:
 Infection
 Cancer
 Autoimmune disease
 IMMUNE SYSTEM
 The overall incidence of infectious disease rises
in late adulthood. Infection diseases, particularly
prevalent among older adults are
 Influenza
 Pneumonia
 Tuberculosis
 Meningitis
 Urinary tract infection.
 IMMUNE SYSTEM
 Cancer increases in prevalence with age such as:
 Leukemia
 Lung
 Prostate
 Breast
 Stomach
 Pancreatic cancer
 IMMUNE SYSTEM
 With aging, the outer skin layer (epidermis) thins, even though the number of
cell layers remains unchanged.
 The number of pigment-containing cells (melanocytes) decreases. The
remaining melanocytes increase in size.
 Aging skin looks thinner, paler, and clear (translucent).
 Large pigmented spots, including age spots, liver spots, or lentigos, may
appear in sun-exposed areas.
 Changes in the connective tissue reduce the skin's strength and elasticity
known as elastosis and more noticeable in sun-exposed areas (solar
elastosis).
 Elastosis produces the leathery, weather-beaten appearance common to
farmers, sailors, and others who spend a large amount of time outdoors.
 IMMUNE SYSTEM
 The blood vessels of the dermis become more
fragile that leads to:
 Bruising
 Bleeding under the skin (often called senile purpura)
 Cherry angiomas
 IMMUNE SYSTEM
 Sebaceous glands produce less oil as you age.
 Men experience a minimal decrease, most often after the
age of 80.
 Women gradually produce less oil beginning after
menopause.
 This can make it harder to keep the skin moist, resulting in
dryness and itchiness.
 The subcutaneous fat layer thins so it has less insulation
and padding.
 IMMUNE SYSTEM
 This increases your risk of skin injury and reduces your ability to
maintain body temperature because you have less natural
insulation, you can get hypothermia in cold weather.
 The sweat glands produce less sweat that makes it harder to
keep cool.
 Your risk for overheating or developing heat stroke increases.
 Growths such as:
 Skin tags
 Warts
 Rough patches (keratoses)
 IMMUNE SYSTEM (EFFECT OF
CHANGES)
 As you age, you are at increased risk for skin injury.
 Your skin is:
 thinner
 more fragile
 lose protective fat layer
 You also may be less able to sense:
 touch
 pressure
 vibration
 heat
 and cold
 IMMUNE SYSTEM (EFFECT OF
CHANGES)
 Rubbing or pulling on the skin can cause skin tears.
 Fragile blood vessels can break easily.
 Bruises, flat collections of blood (purpura), and raised
collections of blood (hematomas) may form after even a minor
injury.
 Pressure ulcers can be caused by:
 skin changes
 loss of the fat layer
 reduced activity
 poor nutrition
 and illnesses
 IMMUNE SYSTEM (EFFECT OF
CHANGES)
 Sores are most easily seen on the outside surface of the
forearms, but they can occur anywhere on the body.
 Aging skin repairs itself more slowly than younger skin. Wound
healing may be up to 4 times slower.
 This contributes to pressure ulcers and infections.
 IMMUNE SYSTEM (FACTORS AFFECTING
HEALING)

 Diabetes
 Blood vessel changes
 Lowered immunity
 COMMON PROBLEMS
 Skin disorders are so common among older people that it is
often hard to tell normal changes from those related to a
disorder. More than 90% of all older people have some type of
skin disorder.
 COMMON PROBLEMS
 Skin disorders can be caused by many conditions including
Blood vessel diseases, such as
 arteriosclerosis
 diabetes
 heart disease
 liver disease
 nutritional deficiencies
 obesity
 reactions to medicines
 stress
 COMMON PROBLEMS
 Other causes of skin changes:
 allergies to plants and other substances
 climate
 clothing
 exposures to industrial and household chemicals
 indoor heating
 Sunlight can cause:
 Loss of elasticity (elastosis)
 Noncancerous skin growths (keratoacanthomas)
 Pigment changes such as liver spots
 Thickening of the skin
 COMMON PROBLEMS
 Sun exposure has also been directly linked to skin cancers
including:
 basal cell cancer
 squamous cell carcinoma
 melanoma
MAJOR COMPONENTS FUNCTIONAL CAPACITY OF AN
ADULT
 Refers to the ability to perform activities necessary or
desirable in daily life.
 Functional status is directly influenced by health conditions,
particularly in the context of an elder's environment and social
support network.
 Changes in functional status (eg, not being able to bathe
independently) should prompt further diagnostic evaluation
and intervention.
 Measurement of functional status can be valuable in
monitoring response to treatment and can provide prognostic
information that assists in long-term care planning.
MAJOR COMPONENTS
FALL RISK
 The injury rate for older adults falls in the midrange for all age
group, with 196 per 196 per 1000 persons injured among
those aged 65 years old and older (Department of
Commerce, 2010 ).
 Older women have a higher rate of injuries than any adult
female age group whereas the rate among men declines
through the years.
 Accidents rank as the six-leading cause of death for older
adults, with falls leading cause of injury related deaths.
MAJOR COMPONENTS
FALL RISK
 Approximately one-third of community-dwelling persons age
65 years and one-half of those over 80 years of age fall each
year.
 Patients who have fallen or have a gait or balance problem
are at higher risk of having a subsequent fall and losing
independence.
 An assessment of fall risk should be integrated into the
history and physical examination of all geriatric patients
(algorithm 1). (See "Falls in older persons: Risk factors and
patient evaluation", section on 'Falls risk assessment' and
"Causes and evaluation of neurologic gait disorders in older
adults".)
MAJOR COMPONENTS
COGNITION
 It decreases with age due to cumulative nature of lifestyle
choices (e.g., in the realm of nutrition, self- neglect, or
substance use or abuse).
 The incidence of dementia increases with age, particularly
among those over 85 years, yet many patients with cognitive
impairment remain undiagnosed. The value of making an
early diagnosis includes the possibility of uncovering treatable
conditions. The evaluation of cognitive function can include a
thorough history and brief cognition screens.
MAJOR COMPONENTS
COGNITION
 If these raise suspicion for cognitive impairment, additional
evaluation is indicated, which may include detailed mental
status examination, neuropsychologic testing, tests to
evaluate medical conditions that may contribute to cognitive
impairment (eg, B12, thyroid-stimulating hormone [TSH]),
depression assessment, and/or radiographic imaging
(computed tomography [CT] or magnetic resonance imaging
[MRI]).
MAJOR COMPONENTS
MOOD
 Psychological changes can be influenced by general health
status, genetic factors, educational achievements, activity and
physical and social changes.
 Depressive illness in the elder population is a serious health
concern leading to unnecessary suffering, impaired functional
status, increased mortality, and excessive use of health care
resources.
MAJOR COMPONENTS
POLYPHARMACY

 Older persons are often

prescribed multiple medications
by different health care providers,
putting them at increased risk for
drug-drug interactions and
adverse drug events. The
clinician should review the
patient's medications at each
visit.
 The best method of detecting
potential problems with
polypharmacy is to have patients
MAJOR COMPONENTS
POLYPHARMACY
 As health systems have moved
towards electronic health
records and e-prescribing, the
potential to detect potential
medication errors and
interactions has increased
substantially.
 Although this can improve
safety, record-generated
messages about unimportant
or rare interactions may lead to
"reminder fatigue."
MAJOR COMPONENTS
POLYPHARMACY
 The high prevalence of health condition in the older
population causes this group to use a large member and
variety of medication. Drug use by older adults has been
steadily increasing every year, most older people use at least
one drug regularly.
 Researchers have found that the number of drugs used by
older persons increase with age.
 SOCIAL SUPPORT
 Social support is characterized by the functional and
qualitative dimension of the network of social
relations and may be offered by means of help, care
or instrumental, economic social, physical and
emotional accompaniment, exercised reciprocally or
unilaterally.
 Having a positive social lifestyle can increase an elderly
person's psychological and physical well-being,
lowering their amount of stress, and helping treat issues
such as anxiety or depression.
 SOCIAL SUPPORT
 The existence of a strong social support network in an
elder's life can frequently be the determining factor of
whether the patient can remain at home or needs
placement in an institution.
 A brief screen of social support includes taking a social
history and determining who would be available to the
elder to help if he or she becomes ill.
 SOCIAL SUPPORT
 Early identification of problems with social support can
help planning and timely development of resource
referrals.
 For patients with functional impairment, the clinician
should ascertain who the person has available to help
with activities of daily living.
 FINANCIAL SUPPORT
 Older adults’ financial situations are a function of their
income, wealth, costs, and debts, with housing costs a
major piece of the household budget.
 The financial situation of a functionally impaired older
adult is important to assess. Elders may qualify for state
or local benefits, depending upon their income.
 Older patients occasionally have other benefits such as
long-term care insurance or veteran's benefits that can
help in paying for caregivers or prevent the need for
institutionalization.
 FINANCIAL SUPPORT
 Older adult patients who are appropriate for CGA have
limited potential to return to fully healthy and
independent lives. Hence, choices must be made about
what outcomes are most important for them and their
families.
 Goals of care often differ from advance care
preferences that focus on future states of health that
would be acceptable, determination of surrogates to
make decisions, and medical treatments.
 FINANCIAL SUPPORT
 Generally, advance directives are framed in the context
of future deterioration of health status.
 By contrast, a patient’s goals of care are often positive
(eg, regaining a previous health status, attending a
future family event). Frequently, social (eg, living at
home, maintaining social activities) and functional (eg,
completing ADLs without help) goals assume priority
over health-related goals (eg, survival).
 FINANCIAL SUPPORT
 They are also patient-centric and individualized. For
example, regaining independent ambulation after a hip
fracture may be a goal for one patient whereas another
might be content with use of a walker.
 Both short-term and longer-range goals should be
considered and progress towards meeting these goals
should be monitored, including reassessment if goals
are not met within a specified time period. One
approach that has been used in CGA is Goal Attainment
Scaling .
 ADVANCE CARE PREFERENCE
 Clinicians should begin discussions with all patients
about preferences for specific treatments while the
patient still has the cognitive capacity to make these
decisions.
 These discussions should include preparation for in-the-
moment decision-making which includes :
 choosing an appropriate decision-maker
 clarifying and articulating patients’ values over time
 thinking about factors other than the patient's stated
preferences in surrogate decision-making.
 ADVANCE CARE PREFERENCE
 As an example, patients who want to extend their life as
long as possible might be asked about what should be
done if the patient’s health status changes and doctors
recommend against further treatment, or if it becomes
too hard for loved ones to keep them at home.
 Advance directives help guide therapy if a patient is
unable to speak for him or herself and are vital to caring
optimally for the geriatric population:
 ADVANCE CARE PREFERENCE
 Advance care planning is one key element to achieving
patient autonomy by allowing patients to participate in
decisions about their medical care.
 Advance care planning is based on the premise that on-
going discussions about end-of-life issues accompanied
by written advance directives are valuable to help loved
ones, physicians, and other providers better understand
and make treatment decisions consistent with patients'
wishes, if the patient becomes incapacitated.
ADDITIONAL COMPONENTS
NUTRITION/WEIGHT
 Older persons are particularly vulnerable to malnutrition.
Moreover, attempts to provide them with adequate nutrition
encounter many practical problems.
 First, their nutritional requirements are not well defined.
 Since both lean body mass and basal metabolic rate decline with
age, an older person’s energy requirement per kilogram of body
weight is also reduced.
ADDITIONAL COMPONENTS
URINARY INCONTINENCE
 Urinary frequency, urgency, and nocturia accompany bladder
changes with age. Bladder muscles weaken and bladder
capacity decreases.
 Emptying of the bladder more difficult; retention of large volumes
of urine may result.
ADDITIONAL COMPONENTS
SEXUAL FUNCTIONS
 Many people want and need to be close to others as they grow
older.
 It includes the desire to continue an active, satisfying sex life.
 With aging, that may mean adapting sexual activity to
accommodate physical, health, and other changes.
ADDITIONAL COMPONENTS
VISION/HEARING
 Change in vision is due to alteration to structural components of
the visual system.
 The sharpness of your vision (visual acuity) gradually declines.
 The most common problem is difficulty focusing the eyes on
close-up objects. This condition is called presbyopia. Reading
glasses, bifocal glasses, or contact lenses can help correct
presbyopia.
ADDITIONAL COMPONENTS
VISION/HEARING
 Common eye disorders that cause vision changes that are NOT
normal includes:
 Cataracts- clouding of the lens of the eye
 Glaucoma-rise in fluid pressure in the eye
 Macular degeneration- disease in the macula (responsible
for central vision) that causes vision loss
 Retinopathy -- disease in the retina often caused by
diabetes or high blood pressure
ADDITIONAL COMPONENTS
VISION/HEARING
 Hearing occurs after sound vibrations cross the eardrum to the
inner ear.
 The vibrations are changed into nerve signals in the inner ear
and are carried to the brain by the auditory nerve.
 Structures inside the ear start to change and their functions
decline. Your ability to pick up sounds decreases.
 You may also have problems maintaining your balance as you
sit, stand, and walk.
ADDITIONAL COMPONENTS
DENTITION
 Only in the last decade has the possible effect of oral health on
the general health and mortality of elderly people attracted much
attention.
 An association between number of teeth and mortality has been
reported in several studies. As people age, many lose teeth.
 Tooth loss reduces masticatory capacity, which can influence
food selection, nutritional status, and general health.
 Evidence is also increasing that oral infections play a role in the
pathogenesis of some systemic diseases.
ADDITIONAL COMPONENTS
LIVING CONDITIONS
 The World Health Organization defined quality of life as an
“individual perception of his or her living situation, understood in
a cultural context, value system and in relation to the objectives,
expectations and standards of a given society”.
 From this perspective, health-related quality of life includes
areas such as physical health, psychological state, level of
independence of the person, personal relationships, beliefs in a
particular context or the natural environment, social support, and
perceived social support.
ADDITIONAL COMPONENTS
SPIRITUALITY
 Is the essence of our being that transcends and connect us to
the Divine and other living organisms. It involves relationships
and feelings (Eliopoulos, 2014).
 Spiritual Needs
 Love
 Meaning and purpose
 Hope
 Dignity
 Forgiveness
 Gratitude
BEST INDICATION FOR CGA
AGE
 Older people admitted for acute inpatient hospital care are at
high risk of adverse events, long stays, readmission and long
term care use.
 There is considerable evidence on assessment and co-
ordination of care for older patients with complex needs using
Comprehensive Geriatric Assessment.
BEST INDICATION FOR CGA
MEDICAL COMORBIDITY
 Older adults generally have multiple medical
problems as well as subclinical changes in
several physiologic systems.
BEST INDICATION FOR CGA
PSYCHOLOGICAL DISORDERS
 Mental health indicates a capacity to cope
effectively with and manage life’s stresses in an
effort to achieve a state of emotional
homeostasis.
BEST INDICATION FOR CGA
PSYCHOLOGICAL DISORDERS
 Selected Mental Health Conditions:
 Depression
 Anxiety
 Alcohol abuse
 Hypochondriasis
 Specific geriatric condition:
 Dementia
 Fall
NCM 114: UNIT 2
CONDUCTING ASSESSMENT
 CONDUCTING ASSESSMENT
 Geriatric conditions such as functional impairment and
dementia are common and frequently unrecognized or
inadequately addressed in older adults.
 Identifying geriatric conditions by performing a geriatric
assessment can help clinicians manage these conditions and
prevent or delay their complications.
 Geriatric syndrome is a term that is often used to refer to
common health conditions in older adults that do not fit into
distinct organ-based disease categories and often have
multifactorial cause.
 CONDUCTING ASSESSMENT
 The lists includes gait disorders
conditions such as: pressure ulcers
cognitive impairment sleep disorders
delirium sensory deficits
incontinence fatigue
malnutrition dizziness
falls
 CONDUCTING ASSESSMENT
 These conditions are common in older adults, and they may have a
major impact on quality of life and disability.
 Geriatric syndromes can best be identified by a geriatric assessment.
 Although the geriatric assessment is a diagnostic process, the term is
often used to include both evaluation and management.
 Geriatric assessment is sometimes used to refer to evaluation by the
individual clinician (usually a primary care clinician or a geriatrician)
and at other times is used to refer to a more intensive
multidisciplinary program, also known as a comprehensive geriatric
assessment (CGA).
 CONDUCTING ASSESSMENT
 The range of health care professionals working in the
assessment team varies based on the services provided by
individual comprehensive geriatric assessment (CGA)
programs.
 CONDUCTING ASSESSMENT
 In many settings, the pharmacists
CGA process relies on a psychiatrists
core team consisting the psychologists
following: dentists
clinician audiologists
nurse podiatrists
social worker opticians
physical and
occupational therapists
dieticians
 CONDUCTING ASSESSMENT
 These professionals are usually on-staff in the hospital setting and
are also available in the community, access to and reimbursement
for these services have limited the availability of CGA programs.
 Traditionally, the various components of the evaluation are
completed by different members of the team, with considerable
variability in the assessments.
 The medical assessment of older persons may be conducted by a
physician (usually a geriatrician), nurse practitioner, or physician
assistant.
 The core team (geriatrician, nurse, social worker) may conduct only
brief initial assessments or screens for some dimensions.
NCM 114: UNIT 3
INFORMATION TO BE COLLECTED
 ABILITY TO PERFORM FUNCTIONAL
TASK AND NEED FOR ASSISTANCE
• The assessment of functional abilities in older adults
refers to a comprehensive assessment to determine the
level of independence that older adults have when
performing activities of daily living.
• This assessment enables the planning of therapeutic
interventions, social care and clinical support, and also
supports clinical reasoning in detecting early signs of
dementia.
 FALL HISTORY
• Falls are defined as an unintentional lowering to rest from a
higher to a lower position, not due to loss of consciousness or
violent impact (Kellogg International Work Group on the
Prevention of Falls by the Elderly, 1987).
• Falls often go unrecognized by health care professionals
because they are not routinely evaluated while taking a
patient’s history or during a physical exam (unless there is
frank injury).
• Many patients do not admit to falling for fear of losing their
independence.
 FALL HISTORY CONT…
• Many factors that contribute to fall risk in older adults. The World
Health Organization Europe (2004) has characterized risks into
two broad categories, intrinsic and extrinsic risk factors for falls.
• Intrinsic risk factors include a history of falls, age, gender,
medical conditions, impaired mobility and gait, sedentary
behavior, psychological status, nutritional deficiencies, impaired
cognition, visual impairments and foot problems.
• Many older adults have multiple comorbidities including
neurological, cardiovascular, metabolic, urinary, musculoskeletal,
and psychological disorders that may increase their risk of falls.
URINARY AND FECAL INCONTINENCE
• Urinary incontinence the ability of the kidneys to
regulate the concentration of the bodily substances
according to need diminishes with age.
• Pain in older adults is common and has a tremendous
impact on quality of life in this age group.
• There is great variability in the reported prevalence,
likely due to differences in the reporting period for pain,
the intensity of pain reported, and composition of the
older population studies.
 URINARY AND FECAL INCONTINENCE
CONT…
• Crook et al 5 reported age-specific rates 29% for those aged
between 71 and 80 years when asked “how often are you troubled
by pain during the past 2 weeks…” Brattburg et.al. reported a 12-
month prevalence of mild to severe pain in 75% in those over 75
years of age.
• Epidemiologic studies commonly show that pain affecting joints,
feet, and legs is increased with age; that pain in the head,
abdomen, and chest is reduced; but back pain frequency varies
widely.7, 8, and 9.
• The high prevalence of degenerative joint disease overwhelms any
contribution from other causes in all surveys.
NCM 114: UNIT 4
ELDERLY CLIENTELE DESIRE
 ELDERLY CLIENTELE DESIRE
 Be recognized as a person and not regarded as a room number, a
disease,
 Be comforted ,to have distress recognized, perceived that health
workers are making efforts to make him physically and emotionally
comfortable, the aged person can tolerate pain if he or she is not being
neglected.
 Learn what is causing health problems or distress in terminology that he
or she can understand.
 Know what treatment and care is planned, length of treatment and what
can be expected as an end result.
 Have some self- determination what about activities he or she will take
part in so long as he or she does not injure self or others.