A Comprehensive Evaluation By A Team Of Healthcare Providers

(helpguide, 2012) Effective care for older patients requires an accurate assessment of the elderly's health status. Physical, psychological, social, and behavioral and health system factors may influence their health status. Functional health status includes: a) basic activities of daily living; dressing, feeding, bathing, toileting, transfer-moving inside and round the house, b) instrumental activities of daily living; shopping, laundry, cooking, housekeeping, taking medication, managing money, c) advanced activities of daily living; social activity, occupation, recreation. Cognitive function assessment includes: attention span, concentration, intelligence, judgment, learning ability, memory, orientation, perception, problem solving, psychomotor ability, reaction time, social intactness. (ispub, 2012)

Statement of the Problem/Issue: Providing geriatric patients with better options for mental healthcare is an ongoing issue in long-term care statewide. Under the Omnibus Budget Reconciliation Act (OBRA) of 1987, congress made a Preadmission screening and resident review program (PASRR), to help alleviate worries that numerous individuals with genuine emotional instability and mental impediment were living in nursing homes that lacked sufficient assets to suitably meet their needs. PASRR enactment obliges state Medicaid organizations to implement programs that screen and distinguish nursing facility applicants and residents with chronic mental illnesses (Shea & Russo, 2001).

Being an older adult in need of services is challenging and, seemingly, discouraging due to the lack of services available. Amplify the typical challenges of older adults

Today, many Americans are affected by health care decisions made without their prior knowledge. More than likely most Americans are unsure how those decisions are decided and who is responsible for making those decisions that ultimately affect how health care is administered. The Department of Health and Human Services (HHS) is the United States government’s principle agency for protecting the health of all Americans and for providing essential human services, especially to those who are unable to help themselves. HHS administrators over two hundred programs and it accounts for almost forty percent of all United States federal government spending. HHS mission is to keep Americans safe and healthy through effective health and human service programs. The department has five strategic goals: strengthen health care, advance scientific knowledge and innovation, advance the health, safety, and well-being of the American people, increase efficacy, transparency, and accountability of HHS programs and strengthen the Nation’s health and human service infrastructure and workforce (Department of Health and Human Services, (n.d.).

Caregiver assessments ought to incorporate a family centered perspective, which should be comprehensive of the needs and preferences of both the caregiver and care receiver (Feinberg & Houser, 2012). Caregiver assessments outcome is a plan of care that was established collaboratively by both the caregiver and practitioner (Feinberg & Houser, 2012). An effective and complete assessment is a important part in deciding on suitable support services for caregivers, particularly when the care receiver’s plan of care dependent upon the contributions of family members and/or close friends. (Feinberg & Houser, 2012).

This assessment also corresponded with competence #1, “Incorporate professional attitudes, values, and expectations about physical and mental aging in the provision of patient-centered care for older adults and their families”(Touhy & Jett 2012).

Recognition, evaluation and treatment of this population requires interdisciplinary approach. The interdisciplinary approach collaborate with various groups to provide adequate resources to the vulnerable population. The internal and external factors impact health status of older adults and contributes to vulnerability risk. The internal factor occur due to physiological changes such as increasing age, gender, sensory impairment, memory impairment, substance abuse along with medical co morbidities, malnutrition, decrease in performance of activity of daily living or dependency on care giver or

At On Lok, the interdisciplinary team, (which consists of a physician, nurse, social worker, physical and occupational therapists, transportation staff, geriatric aids, nutritionist, office manager, and recreational activity leaders), is tasked with identifying and addressing the elder’s personal and medical needs. Prior to enrollment, all members of the interdisciplinary team prepare an assessment of the candidate and then come together to develop a comprehensive treatment plan. The treatment plan is then presented to the participant and his/her family for consensus. The team then coordinates the delivery of senior care services, monitors the participant’s progress, and adjusts the treatment plan according to the participant’s current needs.

The Likert scale ranges from 0 (never) to 4 (all the time). It can also be used with caregivers who may have witnessed clinical cases of abuse. This may be useful with individuals who have dementia and may not be able to recall the abuse themselves. A more objective measure is The Minimum Data Set Abuse screen (MDS-A). This is a reliable, observer-rated measure that involves an interview with the elderly individual. The individual is identified as positive for possible abuse if certain indicators are present. These indicators include fear towards a caregiver, poor hygiene, unexplained injuries, untreated or not acknowledged conditions, and physical restraints. In addition to current measurement methods, staff reporting of abuse can help tremendously.

Furthermore, through these assessments, they can formulate relevant treatment plans for service users based on the necessary information gathered (Orrell et al., 2013; Yuan et al., 2011). The implementation of a more holistic assessment through which patients would be seen in their own homes and where nurses can have a look at service users’ facilities and living conditions as they can be quite often be part of the issue is an effective strategy for promoting continence (Orrel et al., 2013). Moreover, the National Institute of Health and care Excellence (NICE, 2014) has implemented guidelines on the importance of assessing the nursing needs of service users when making decisions on patient care. There exists however discrepancies around patient assessments which range from bypassing the assessment process to mistrust regarding the accuracy of assessments provided by district nurses to the elderly who are in nursing homes or housebound (Peters et al., 2004; Yuan et al., 2011, Orrell et al., 2013). They usually just perform rapid assessments of products without

During my clinical rotations I have had numerous oppurtunities to asses the mental health status of elderly patients. The majority of the mental health assessements that I conducted were in accordance with the Medicare annual wellness assessment. The Medicare annual wellness is apart of the Afforable Care Act program aimed towards improving, preventing and managing the healthcare of patients.

A mini mental state examination is performed regularly to measure the patient’s cognitive function. According to Herrmann, N., & Gauthier, S. (2008), “the Global Deterioration Scale may provide a better measure of overall severity”. (p. 1280). The Global Deterioration Scale is performed after the patient is interviewed so the physician has a better understanding of the patient’s needs and the ability to function day to day. Questions that the physician should be asking the primary caregiver during the interview should be focused towards; does patients ability to communicate, does the patient recognizes familiar faces, does the patient get lost within a familiar place, and does the patient need assistance in order to perform activates of

Geriatric health assessment tools are designed to evaluate an individuals functional capacity, physical well being, perception and mental well being. It is normally begun when the Doctor distinguishes a potential issue. Specific components of physical well being that are evaluated incorporate sustenance, vision, hearing, fecal and urinary self restraint, and balance. The geriatric assessment helps in the analysis of theuraputic conditions ; improvement of treatment and follow up arrangements; coordination of administration of care; and assessment of long-term care needs and ideal placement. The geriatric assessment differs from a standard medical evaluation by including nonmedical domains; by emphasizing functional capacity and quality of

Children and the elderly are a dependent demographic. Their dependence on their caregivers for sustenance makes them vulnerable to abuse. Abuse can manifest in two forms physical and non-physical abuse. While the victims of aggressive attacks are easily identifiable leading to appropriate actions taken against the culprits, the majority of abuse incidences are latent. Therefore, it is extremely important for nurses to key and discern those types of signs and symptoms presented as possible child/elderly abuse. The rate of elderly abuse is set to surpass child abuse cases given that the United States is an aging nation. The nursing faculty should leverage the resources available such as a checklist to help determine neglect and suspected abuse. The majority of cases of abuse go unreported owing to the inability or fear of the victims to report their situation. Different states have variation from the federal regulations regarding handling abuse cases. The nurses are central in the fight against dependent abuse.

There are various factors that may contribute to one’s quality of life. However, many older adults struggle with their well being and this is just as important as the quality of their life. When evaluating an older adult, one must take into consideration the following factors: the individual’s acute and/or chronic illnesses; medications currently taking; functional status; mental health and cognitive abilities; and their living situation. Gathering this information is based on the individual’s medical history as well as their social history. However, the goal is to make recommendations to improve the quality of life for the individual as one sees applies.