A Treasure Trove of Educational Resources for Gerontological Nursing

VickyRN, MSN, DNP, RN

The John A. Hartford Foundation was established in 1929 by bequest of its founders, the two brother heirs of the Great Atlantic and Pacific Tea Company fortune. The mission of the Hartford Foundation is to "improve health care for older Americans."

The Hartford Institute for Geriatric Nursing offers the following marvelous resources free of charge to help promote gerontological nursing: the General Assessment Try This series, the Specialty Practice Series, and the Dementia Series.

In this blog entry we discuss the General Assessment Try This series, a valuable assortment of articles, videos, and case studies. These 30 assessment tools are a treasure trove of best practices that are easy to understand and implement. For your convenience, eight of the assessment tools are highlighted below.

SPICES Assessment

The care of older adults is intricate and complex, encompassing three levels of complexity. The majority of older patients have two or more coexisting chronic conditions (comorbidity) and as a result, often require much more intervention and care while hospitalized than younger patients. To adequately care for the geriatric population, nurses need a framework for assessing common geriatric conditions. The SPICES framework covers six critical marker conditions: Sleep, Problems with eating and drinking, Incontinence, Confusion, Evidence of falls, and Skin.

Katz Index of Independence in Activities of Daily Living (ADL)

This index is the most appropriate instrument to monitor basic functional ability. It ranks ability to perform six fundamental self-care activities: bathing, dressing, toileting, transferring, continence, and feeding. The inability to perform ADLs equates to severe functional impairment. This instrument is also useful for detecting subtle changes in health or atypical signs or symptoms that may signify acute illness in the older adult population.

The Lawton Instrumental Activities of Daily Living (IADL) Scale

Instrumental activities of daily living are not necessary for fundamental functioning, but are skills sets that enable the individual to live independently within a community. The inability to perform IADLs equates to moderate functional impairment. This scale measures a person's ability to perform tasks such as preparing meals, taking medications, doing laundry, shopping for groceries or clothes, using the telephone, and managing money. It consists of eight domains and can be administered in 10 to 15 minutes.

The Mini-Cog Mental Status Assessment of Older Adults (the Mini-Cog)

This screening tool consists of a three-item recall and a clock drawing test. It can be used to quickly identify cognitive impairment or dementia. This instrument is reliable and valid, easy to use, and takes only three to five minutes to administer. A positive Mini-Cog screen indicates the need for further testing for dementia. This tool can also help differentiate between dementia and delirium.

Confusion Assessment Method (CAM)

This screening tool indicates the presence or absence of delirium. It assesses four key features to distinguish delirium from other types of cognitive impairment: (1) Acute onset and fluctuating course; (2) Inattention; (3) Disorganized thinking; and (4) Altered level of consciousness.

Geriatric Depression Scale (GDS)

Depression is a widely under-recognized and undertreated medical condition in the elderly population; it certainly is not a normal part of aging. The risk of depression within this age group increases with the incidence of chronic illness and loss of functionality. Depression may manifest atypically within this population as tiredness, somatic complaints, and non-specific aches and pains. Therefore, it is often not recognized and treated. The Geriatric Depression Scale is a brief 30-item questionnaire designed specifically to identify depression in the elderly. This tool has been tested and used extensively in the geriatric population since the early 1980s and is considered valid and reliable. A short form is also available that consists of 15 questions and takes 5 to 7 minutes to complete.

Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model

One of the most significant concerns about safety in the older adult population relates to falls. Falls account for more than 70% of the total injury-related health cost and are the leading cause of accidental death in this age group. Most falls occur in the home during normal routines. Approximately one-third of older adults who live at home and two-thirds of older adults who reside in long-term care facilities fall each year. Prevention of falls in the elderly population, therefore, has become a priority goal of gerontological nursing. The Hendrich Fall Risk Model is quick to administer and versatile in that it can be used in any client care setting. The scale determines fall risk based on the following factors: confusion, depression, altered elimination, dizziness, gender, the administration of antiepileptics and benzodiazepines, and "Get Up & Go."

The Modified Caregiver Strain Index (MCSI)

Since informal family caregivers provide the bulk of long-term care services for dependent seniors within the community, meeting the needs of the caregivers has become a pressing issue as the population ages. Thirty-two percent of informal caregivers nationwide report a high burden of care. Caregivers are at risk for depression, fatigue, grief, social isolation, and physical health problems. The Modified Caregiver Strain Index (CSI) is a 13-question instrument that can be used to quickly screen for caregiver strain with informal family caregivers. The higher the score, the higher is the level of stress.

In addition to the topics highlighted within this blog, other geriatric assessment tools address sleep, nutrition, hearing, oral health, immunizations, transitions to care, sexuality, fatigue, preventing aspiration, urinary incontinence, pressure ulcers, inappropriate medication use, elder abuse, alcohol use, and post-traumatic stress.

References

ConsultGeriRN.org

The John A. Hartford Foundation