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Fulmer’s SPICES Assessment Tool

By Asia Elmi and Ilhan Abshir

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.

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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