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Functionalassessment1.pptxFulmer’s SPICES Assessment Tool
SPICES assessment tool background
Terry Fulmer first created the Fulmer SPICES assessment tool at the New York University College of Nursing in 1988. It was created to focus assessments and guide nurses and providers to ensure the geriatric patient's overall health is being well taken care of instead of focusing solely on the patient's initial reason for being there.
What is it?
SPICES is an acronym for the six common syndromes affecting geriatric patients:
S: Sleep disorders
P: Problems with eating and feeding
I: Incontinence
C: Confusion
E: Evidence of falls
S: Skin breakdown
Its goal is to identify risks, develop efficient care plans, and discern the need for further evaluation.
Sleep Disorders
Sleep problems are a range of ailments that impair one's capacity to get enough sleep.
Symptoms
Weariness during the day
A great desire to sleep during the day
Odd breathing habits
Inability to concentrate
Depression
Gaining weight
Anxiety or irritation
Sleep disorders in older adults involve any disrupted sleep pattern. This can include problems falling or staying asleep, too much sleep, or abnormal behaviors with sleep.
Alzheimer disease
Alcohol, certain medicines and stimulants such as caffeine and nicotine
Long-term (chronic) disease, such as heart failure
Brain and nervous system conditions
Depression (depression is a common cause of sleep problems in people of all ages)
SPICES helps assess this by asking questions such as "how well do you typically sleep?"
What causes sleep disturbances in older adults and how does SPICES fit into this?
An eating problem is any relationship with food that you find difficult. Symptoms related to eating and feeding problems include:
In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
Skipping meals or taking small portions of food at regular meals
Extreme concern with body size and shape
Anxiety, or depression
Extreme mood swings
Problems with eating and feeding
In the aging group, eating problems are caused by specific health conditions such as:
Gastrointestinal ailments
Malabsorption Disorders
Chronic and acute infections
Ill- fitting dentures
Difficulty swallowing and chewing
SPICES helps assess this issue by providing a foundation for questions such as: do you have trouble or pain when swallowing or eating?
What usually causes it in elders and how does SPICES assess it?
Incontinence is the term for uncontrollable urine leaking, which is more common in seniors. Incontinence can occur due to situations such as overflow and stress.
Symptoms
Feeling a strong desire to urinate
Leaking as a result of an ailment like arthritis or Alzheimer's illness
Defects with the nerves and muscles that assist the bladder to hold or release urine
Overweight
Incontinence
What causes it in older people? How does SPICES help diagnose it?
Incontinence is usually caused by
Weak bladder muscles
Weak pelvic floor muscles
And in men most times it is related to the prostate gland.
SPICES helps by asking questions such as "how often do you urinate?" As well as bringing attention to the necessary diagnosis tools like a bladder stress test.
Confusion is a common issue with patients over 60. As their cognitive ability declines, they can either have acute disorientation or progress further into delirium. Most causes of confusion can be identified with the help of extensive and comprehensive medical history and labs, and mental evaluations.
Confusion
Signs and symptoms include but are not limited to:
Loss of awareness about surroundings and time
Slurred speech
Forgetting a task in the midst of performing it
Sudden mood swings
Causes of confusion in seniors and how SPICES diagnoses it
Some common causes of confusion include:
Infections like a UTI or respiratory tract infection
Alzheimer's
Asthma (as oxygen intake can mess with cognitive functions)
Malnutrition and vitamin deficiencies
Mental health problems such as depression and schizophrenia
Physical injury like a head injury
SPICES deals with this by bringing focus to the patients mental state by asking questions like "what is the patient's level of alertness?"
Evidence of falls
Falls in older people are a sign of weakness, immobility, and acute/chronic health problems. Falls reduce function by causing injuries, occupational restrictions, fear and anxiety of falling, and flexibility loss. Falls cause most injuries in the elderly, such as fractures of the hip, arm, shoulder, and pelvis are common due to the cumulative impact of falls.
Issues with their vision
Strength and fitness difficulties
Chronic illnesses
Side effects of medications
Physical hazards within their environment
Hazards caused by their own actions and lifestyle choices
Weaknesses caused by surgery
SPICES brings to action a thorough assessment of the patients fall risk by asking questions like "Have you fallen in the past six months or afraid to?"
The main causes of falls in the elderly and SPICES's role in it:
Skin breakdown starts as a red or purple spot on fair skin or a shiny, purple, blue, or darker area on dark skin, which does not fade or go away within 20 minutes.
Signs of skin problems include:
Reddened or darkened areas.
Any change in the color of the skin.
Bruises.
Warm areas felt near a red, dark, raised or hardened area.
Rashes
Swelling
Skin breakdown
Pressure
Shearing
Friction
Accidents
Moisture
Swelling
Immobility
SPICES evaluates this by checking for ulcers, and observing the entire body surface for irregularities and frailty
Causes of Skin Problems and how SPICES assesses it
SPICES in Action
Summary of Website and Article
Website:
SPICES is an important tool for developing care plans that are centered more on the client and less on specific illnesses. It's is used to make long term plans of care for geriatric patients and the upkeep of these plans can then be delegated to LPNs and other healthcare workers from the interprofessional team.
https://www.iadvanceseniorcare.com/spices-helps-develop-care-plan/
Scholarly article:
Geriatric conditions are often preventable and, there are many modifiable risks involved as well. SPICES helps decipher what these risks are and how best to care for their long-term health and wellbeing. This would allow the nurses to begin then leading client-centered plans. And in the event there is proven evidence for one of the markers, then there can be follow-up assessments using other validated tools.
https://www-proquest-com.mtrproxy.mnpals.net/docview/2534658614?pq-origsite=primo
References
Center, S. (2018). Causes and signs. Causes and Signs - My Shepherd Connection. Retrieved October 13, 2021, from https://www.myshepherdconnection.org/sci/skin-care/causes-signs%20%E2%80%8B%20%20%E2%80%8B.
Contributor, N. T. (2019, August 1). Feeding problems in elderly patients. Nursing Times. Retrieved October 11, 2021, from https://www.nursingtimes.net/roles/older-people-nurses-roles/feeding-problems-in-elderly-patients-19-04-2001/.
Corgi, S. (2021). Fulmer spices tool in patient health assessment. StudyCorgi.com. Retrieved September 27, 2021, from https://studycorgi.com/fulmer-spices-tool-in-patient-health-assessment/.
Dean, J. (2011). Skin health: Prevention and treatment of skin breakdown. Transverse Myelitis Assoc J, 5, 26-
Dugdale, D. (2020). Sleep disorders in older adults: Medlineplus medical encyclopedia. MedlinePlus. Retrieved October 13, 2021, from https://medlineplus.gov/ency/article/000064.htm.
Espino, D. V., Jules-Bradley, A. C. A., Johnston, C. L., & Mouton, C. P. (1998, March 15). Diagnostic approach to the confused elderly patient. American Family Physician. Retrieved October 12, 2021, from https://www.aafp.org/afp/1998/0315/p1358.html.
References Page 2
Hope, F. (2021, July 14). Warning signs and symptoms. National Eating Disorders Association. Retrieved October 13, 2021, from https://www.nationaleatingdisorders.org/warning-signs-and-symptoms.
Practices, C. D. C. P. (2006). Fulmer spices: An overall assessment tool for older adults. CDC Promising Practices :: Promising Practices :: Fulmer SPICES: An Overall Assessment Tool for Older Adults. Retrieved September 27, 2021, from https://cdc.thehcn.net/promisepractice/index/view?pid=500.
Staff, H. (2021). Confusion, memory loss, and altered alertness. Confusion, Memory Loss, and Altered Alertness | Michigan Medicine. Retrieved October 12, 2021, from https://www.uofmhealth.org/health-library/confu.
Team, the H. E. (2019, August 14). What you should know about confusion. Healthline. Retrieved October 12, 2021, from https://www.healthline.com/health/confusion#signs.
Terry, F. (n.d.). How to Try This: Fulmer SPICES. NursingCenter. Retrieved September 28, 2021, from https://www.nursingcenter.com/ce_articleprint?an=00000446-200710000-00025#:~:text=The%20Fulmer%20SPICES%20framework%2C%20which,which%20a%20patient%20was%20hospitalized.
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