Assessment of Older Adults in Long-Term Care
Through planned, intentional encounters with older adults, nursing students learn to promote human flourishing and to provide competent, individualized, and humanistic care. This teaching strategy focuses on assessment in long-term care clinical settings, and can be used with students in both beginning and advanced nursing courses. Since it is beneficial for learning to assign students to long-term care settings for several weeks, the teaching strategy provides learning activities for a six-week experience. While this teaching strategy focuses on assessment, concurrent learning activities might include coordinating and managing care and making situational decisions.
Assessment of Older Adults in Long-Term Care
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Learning Objectives
Students will:
- Assess older adults’ individual aging patterns and functional statuses using standardized assessment tools such as the Try This:® Series.
- Use effective communication techniques to recognize, respond to, and respect older adults’ strengths, wishes, and expectations.
- Include findings or assessment of older adults’ cognitions, moods, physical functions, and comfort to fully assess the individuals’ aging patterns.
Learner Pre-Work
This teaching strategy focuses on assessment and use of effective communication with older adults, and enhances students’ spirit of inquiry and human flourishing.
1. Each student should be assigned an older adult to assess during his or her long-term care experience. During the six-week experience, the students will complete comprehensive assessments of the older adults. Additional assessment tools may be needed for some individuals and can be found in the Try This:® Series from the Hartford Institute for Geriatric Nursing (HIGN) at the NYU Rory Meyers College of Nursing.
2. Prior to clinical experience, the students should review the assessment tool on the Try This: site. In pre-conference, review the tool with students, discussing purpose, scoring, strengths, and limitations. In post- conference, talk about students’ findings and variations among older adults, limitations of the assessment tool, and indications of need for follow-up care, focusing on the following points related to assessing function and expectations:
- Assess older adults’ individual aging patterns and functional statuses using standardized assessment tools.
- Use effective communication techniques to recognize, respond to, and respect older adults’ strengths, wishes, and expectations.
- Include findings of assessment of older adults’ cognition, mood, physical function, and comfort to fully assess individual aging patterns.
- As a post-clinical reflection exercise, ask each student to write a one-page response to the following questions:
- What have you learned about older adults during this long- term care experience?
- How will you use your newly acquired assessment skills in other clinical settings?
- What is the client’s perception of the quality of his or her life and what goals does the client have?
- Summarize the results from the entire clinical group and report findings to the group as well as to nursing faculty and the curriculum committee.
- Additional Assignment: If time and circumstance allow, have each of the students do assessments on clients in assisted living and compare the findings with clients in long-term care.
Suggested Learning Activities
1. Learning Activity: SPICES - An Overall Assessment Tool
This framework for assessing older adults provides a snapshot of clients’ overall health. It focuses on six common conditions: sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. More specific assessments occur in the following learning activities.
Tool - Video
2. Learning Activity: Cognitive Assessment
The Mini-Cog is a brief (three-minute) screening tool can be used effectively to identify dementia. The tool is composed of three item recall and the Clock Drawing Test. Administration and scoring directions are clear and concise.
Tool - Video
3. Learning Activity: Geriatric Depression Scale
This short-form screening tool takes five to seven minutes to complete. Depression is under-recognized in older adults, especially those with chronic health problems. Differentiating between depression and the frustrations faced by older adults as they deal with the challenges of aging is key to providing adequate care for this age group. Recognizing depression is the first step in treatment.
Tool - Video
4. Learning Activity: Predicting Pressure Injury Risk
This is one of the most widely used tools for predicting development of pressure ulcers in older adults with medical conditions or cognitive impairment. The tool is used to assess risk in six subscore areas: sensory perception, skin moisture, activity, mobility, nutrition, and friction/shear. Subscores range from one (highly impaired) to four (no impairment), and are added together to determine the overall risk (the lower the score, the higher the risk).
Tool - Video
5. Learning Activity: Hendrich II Fall Risk Assessment
While designed for use in acute care settings, this assessment tool is useful in long-term care as well because the risk of falls increases proportionally with the number of pre-existing health problems and “risky” medications. This brief tool allows the nurse to focus on modifying or eliminating specific risk factors.
Tool - Video
6. Learning Activity: Katz Index of Activities of Daily Living
The Katz Index measures a person’s self-care abilities in six categories: bathing, dressing, toileting, eating, transferring, and remaining continent. This tool can help nurses detect subtle changes in health and prevent functional decline.
Tool - Video
Assessment Tools
The Try This:® Series from the Hartford Institute for Geriatric Nursing (HIGN) at the NYU Rory Meyers College of Nursing contains many evidence-based assessment tools. The tool, an article about using the tool, and a video illustrating the use of the tool, are all available for your use.
Author Information
Kellie Bassel, EdS, MSN, RN
Palm Beach State College
Lake Worth, FL
Laureen Tavolaro-Ryley, MSN, RN
Community College of Philadelphia
Philadelphia, PA