Question

Assignment Description The following items are mostly considered in case assessment for patients along the health care continuum. Prepare a hypothetical geriatric case management report involving these (14) bio-psychosocial assessments as related to geriatric patients. 1. Assessment and measurement of physical and functional abilities 2. Nutritional status 3. Medical history 4. Mental health status 5. Family and support systems 6. Spiritual beliefs 7. Cultural beliefs and customs 8. Financial resources 9. Insurance provisions 10. Vocational activities 11. Avocational and recreational pursuits 12. Health literacy and knowledge 13. Health status expectations 14. Readiness to change

Answer 1

Care Plan

1. Examine the client = Assessment

2. Come up with a diagnosis = Problems list

3. Prescribe the solution to the problems = Intervention list 2 + 3 = Care Plan

Physical Health: The first element of a geriatric assessment is a physical assessment that identifies specific diseases or symptoms for which curative, restorative, palliative, or preventive treatment may be available. Special attention is directed toward visual or hearing impairment, nutritional status, incontinence, and conditions that may contribute to falling or difficulty in ambulation. Of course, any actual physical examination should be done by a nurse practitioner or a physician. Gathering health information about the client and reporting it to the physician, through assessment tools, can be done by the care manager who has a background in gerontology, the health sciences, or social work or psychology.

Functional Assessment: A functional assessment is a measure of the person’s ability to adequately and safely perform basic ADLs, including bathing, dressing, toileting, transferring, and feeding. Instrumental activities of daily living (IADLs), such as meal preparation, shopping, housework, financial management, medication management, use of the telephone, and driving, are evaluated by direct observation in the home, interviews with the client and family, and administration of standardized questionnaires.

Caregiving and Ethnic, Social, Spiritual, and Economic Status: Identification of present and potential family caregivers and assessment of their willingness, competence, and acceptability to the older person is determined through interviews with the client’s family and the social network.

Psychosocial Status: The care manager evaluates the cognitive, behavioral, and emotional status of a client. Identification of signs of dementia, delirium, and depression is particularly important.

Environment: Evaluation of the client’s physical environment is essential. Home safety must be evaluated.

Goals of Geriatric Assessment:

Goal Area Examples

1. Education and referrals Information and/or referral for home care, nursing home care, adult day care, rehabilitation services, support groups, and so forth.

2. Social/family relations/activity Provide support to patient and/or family; encourage senior center participation or other activities; provide coping mechanisms for family and caregivers.

3. Functioning and independence Improve activities of daily living or instrumental activities of daily living functioning; gait training; maintain independent living situation.

4. Supervision Enhance supervision of functioning, finances, and so forth.

5. General health and well-being Maintain health and well-being; enhance spirituality.

6. Medication issues Stop, start, change dose of medications; enhance compliance.

7. Medical issues Diagnose and/or treat problems of physical health or functioning.

8. Cognitive issues Maintain memory, diagnose and/or treat cognitive problems.

9. Emotional issues Diagnose and/or treat depression, anxiety, loneliness, and so forth.

10. Health behaviors Improve diet; exercise; limit smoking or drinking, and so forth.

11. Behavioral issues Diagnose and/or treat wandering, aggressive behavior, etc.

12. Caregiver burden Reduce burden of care for family and caregivers, respite care, etc.

13. Driving Evaluate, monitor, improve, or stop driving.

14. Safety Maintain safety in living situation or in functioning.

15. Environmental modifications Adaptations in the home (improve lighting, remove rugs, etc.)

16. Dignity and autonomy Allow patient to make his/her own choices, adapt to impairments; no additional medical treatment; comfort care.

17. Economic stability Maintain financial stability; assess financing of alternative living situations; obtain Title XIX, and so forth.

Assessment, Care Plan, and Recommendations Outline

1. Date assessment and care plan and recommendations were prepared: _________

2. Client demographic information: a. Name b. Address c. Phone number d. Current living arrangement e. DOB f. Marital status or primary relationship g. Gender h. Primary language if not English

3. Information on individual who requested assessment: a. Name b. Address c. Phone number d. Relationship to client

4. Informants other than client who provided information, relationship to client, and dates of contact:

5. Presenting problem (the problem that precipitated the referral for this assessment):

6. Social network status (include current activities and interests, occupational background, spiritual life, living arrangements, nature and frequency of significant social relationships; describe a typical week in the life of the client such as outings, contacts with others):

7. Physical and mental health/medical status (include current medical diagnoses; medications; name of primary care physician, other specialists, dentist, podiatrist; any problems with sleeping, vision, hearing, elimination, speech, respiration, nutritional status, and diet). When listing current conditions, observe whether they are stable, worsening, or improving.

8. Activities of daily living status (include assessment of ability to ambulate, bathe, dress, communicate, eat, maintain continence, shave, maintain oral health, toilet, transfer alone or with assistance; if assisted, indicate by whom or with what equipment):

9. Instrumental activities of daily living status (include ability to shop, prepare meals, do housekeeping and laundry, use telephone, manage medication, do own finances alone or with assistance; if assisted, indicate by whom or with what equipment):

10. Legal status (include whether there are signed healthcare and financial powers of attorney and who the agents are in these documents, whether there is guardianship, whether a living will is signed, whether a current will is in place):

11. Financial status (include current income and assets to determine eligibility for state/federal programs or Veterans benefit programs; include how the client is managing daily money matters and whether there is a trust administrator):

12. Insurance coverage (include information on primary and secondary insurance, long-term care insurance, VA benefits):

13. Summary of concerns and identification of risk factors (specify concerns uncovered in the assessment under the following areas and identify any potential problems of which you are aware regarding possible solutions to these problems, such as client resistance, limited financial resources, or family conflict): a. Safety concerns (include risks identified in the home setting such as hazards on stairs, in kitchen, in bedroom, in bathroom, in living room): b. Mental health, behavioral, or cognitive concerns (include outcome of mental status assessments such as depression screens, mini-mental screens, suicide potential, relevant psychiatric history): c. Driving safety concerns (include whether there is evidence that the client may be driving unsafely): d. Nutrition concerns (include information on change in weight, unhealthy/unbalanced diet, difficulty preparing food): e. Fall risks (include information on fear, clutter, medications, balance, strength, specific conditions): f. Abuse risks (include information on physical, emotional, financial, psychological, neglect, or self-neglect issues): g. Medications/substance abuse/smoking risks (note any compliance issues, polypharmacy issues, obstacles to attaining medications or taking them appropriately, alcohol or overthe-counter medication abuse):

14. Care plan and recommendations (identify each problem/concern uncovered in the assessment. Explain your rationale for each recommendation, and provide at least two alternatives and the cost associated with each alternative). Include referrals needed to any medical or other specialists.

Elements of a Geriatric Assessment Problem

1. Brief client history from birth to crisis that prompted care manager to intervene
2. Written summation of functional assessment
3. Written summation of cognitive assessment
4. List of all medications
5. Written summation of psychosocial assessment
6. Written summation of home environment assessment
7. Written summary of any other pertinent assessment
8. Care plan
9. Written explanation of the care plan
10. Summary of recommendations

Problem Checklist:

Below is a list of the most frequent problems older people experience. If an assessment tool does not address these problems, keep this list handy to draw from when you create a care plan.

1. Self-care deficit
2. Impaired home management
3. Alteration in nutrition
4. Impaired mobility
5. Knowledge deficit
6. Alteration in bowel elimination
7. Alteration in urinary elimination
8. Impaired skin integrity
9. Loneliness
10. Depression
11. Pain
12. Caregiver stress
13. Driving problems