Gerentogoly Wk2 project

Running Head: 9

Assessing and Planning Care for My Elderly Mom

NSG4067: Gerontological Nursing

My subject

I chose my …… as my subject. She is a 68-year-old woman, who is still working full-time as the Vice President of a bank in the small community that she lives in. She is still married to my Dad, with whom she just celebrated her 47th wedding anniversary and, in my opinion, is quite healthy. She has a solid group of friends that regularly eat lunch together as well as take trips together a couple of times a year. She does not take any medications, nor has been diagnosed with any chronic health issues. Although, exercise has never been something she has indulged in, she is still leisurely active around the house and likes to take walks with her dog. Mom loves wine, but has never smoked cigarettes. She agreed to be the subject of my gerontological assessment. Since my subject is not frail but rather very robust for her age, I focused my assessments by using tools that were meant to help gain a better understanding of my subject’s health status and where improvements can be made for optimal health management and disease prevention. In combination with a comprehensive questionnaire, I utilized the Tinetti Balance Assessment Tool to assess gait, and the Katz Index to assess how well subject does with ADLs.

Subject questionnaire

It seems that my subject is very healthy in contrast to other people her age. She feels strong mentally and physically, and has a great attitude towards the way one should live life. She should concentrate on weight management, exercising more regularly, and preventing osteoporosis by including enough calcium in her diet. She should also be sure to have regular, annual checkups such as vision and hearing checks, in addition to her normal blood work.

Subject is not happy with the way she thinks the older generation is treated by younger people or doctors even.

It would seem that the subject’s family has been predisposed to living longer lives, with the exception of her father, who was a heavy, lifelong smoker that died of cancer. So far, subject’s genetics are working in her favor. See Appendix A.

Tinetti Balance Assessment Tool

The Tinetti Gait and Balance Instrument is designed to determine an elders risk for falls within the next year. The higher the score, the better the performance. In performing the balance and gait assessment for my subject, it was found that subject scored as high in points as possible and therefore, has no issues with either balance or gait and is a low risk for falls.

Katz Index

The Katz Index is a tool that assesses functional status as a measure of the patient’s ability to perform activities of daily living (ADLs) on a daily basis. “One of the best ways to evaluate the health status of older adults is through functional assessment which provides objective data that may indicate future decline or improvement in health status, allowing the nurse to intervene appropriately” (Katz, 2007). This tool assesses bathing, dressing, toileting, eating, as well as shopping, transportation, food preparation, and the ability to handle finances, among other things. My subject, again, had a perfect score on this assessment, which shows no signs of a decline in her ability to take care of herself, independently.

INHOMESSS assessment

INHOMESSS stands for: immobility, nutrition, housing, others, medication, examination, safety, spirituality, services, and provides a framework for the evaluation of a patient's functional status and home environment. The subject lives in a safe environment, has no impairments or mobility issues that would cause problems for her, eats fairly healthy, etc. During this assessment, there were only a couple of issues identified. The subject does not have an advanced directive and she admits to needing to exercise more and lose weight.

My subject in relation to the average 68 year old

“Almost 50% of the population older than 65 have osteoarthritis, 40% has hypertension, 33% has chronic heart disease, and more than 25% suffer from hearing impairment” (Barker, 2007, p. 177). My subject is a healthy older woman that has minimal health-related issues. There were several preliminary issues I identified that can be addressed to prevent complications in the future: The subject needs to introduce an exercise regimen into her routine that will help her maintain a healthy heart. She also could benefit from losing some weight, to ensure she maintains optimal cholesterol levels, with a reduction in the amount of fat that sits around her organs. This not only with help her heart and health, but will also have a positive impact on the way she sees herself. In addition, subject should be encouraged to maintain her social network so that she continues to reap the benefits of such alliances.

Interventions for these issues include referring the subject to weight loss resources and gyms in her area, educating the subject on where to find information on nutritional diets, encouraging continued, routine social interaction, and educating subject on the importance of this. Subject also needs to be educated on the importance of having an advanced directive in place so that, in the event she cannot make decisions for herself, her family does not make decisions she would not want for herself.

Appendix A

Patient Questionnaire

INTERVIEW OF CHOSEN ELDER ADULT

Name: Pam Browning Age: 68

Brief Introduction (Background information):

Raised in a rural county in ……. My grandparents were part of my everyday life and the importance of family was instilled at a young age. I graduated from High School and completed some College. I have been a banker all of my career and worked my way up from a clerk to a Vice President and Sr Lender. My father had many health issues starting at the early age of 48 and died at 64. I took care of my mother from the time that I was 40, until she died at 83.

1. Philosophy on living a long life

Enjoy life. Be positive. Help others. Keep your mind and body active and strong.

2. Thoughts about when a person is considered “too old”

I do not believe that a person is ever “too old” to make a difference in other’s lives. I already see some younger people looking at me or speaking to me in a condescending manner and I do not like that. It is as if they do not see me as a viable contributing member to society. You should always do anything that you want without thinking of your age.

3. Opinion on the status and treatment of older adults

I do believe that older people are treated differently. Almost as if they are children and need to be taken care of. Doctors even seem to treat older people differently. Their treatment options and their attitude about those treatment options change as you age. I believe that older people are given up on when they should not be.

4. Beliefs about health and illness

It is important that you take care of yourself both physically and mentally. If you give up and become sedentary then your physical and mental health begin to decline.

5. Health promotion activities he or she participates in

I am part of a wellness program through my work. I keep up with my annual checkups; take any medicines as prescribed and try to eat healthy. I should exercise more.

6. Something special that helped the person live so long

Education as to what I should be doing to keep myself healthy. Positive attitude, enjoyment of life and friends and family. Belief that I am put on this earth to help others.

7. Life span of other family members

Grandfather very active and lived to be 86. Died having hip replacement surgery because he believed that quality of life was more important than quantity. Grandmother lived to be 93 and came from a long-lived family. Mother lived to be 83 and father died at 64 due to cancer.

8. Special dietary traditions in patient’s culture attributed with aiding long life

Growing up, if the food did not come from our garden or the meat from what we raised, we did not eat it.

9. Any remedies/medications that have been handed down in family/group. If yes, describe. None that I can remember

10. Patient’s description of current and past health status

I was sickly as a child. Born with low gamaglobulin and had to have IV drips as a child. As a teenager and adult I have been healthy, with few health issues.

11. The values that guided life so far

Work hard. Treat others the way that you would want to be treated. Help others. Love your family. Always look to the positive.

12.What do you think about cosmetic procedures to delay the aging process?

I believe that if they help make you feel better about yourself then you should consider it.

13. Do you have any big regrets in your life?

Yes. I wish that I had completed my college degree. Also, I worked outside of the home my entire life and looking back I wish that I had spent more time with my children.

14. Are you satisfied with your level of daily physical activity?

No. I should exercise more.

Summary

It seems that my subject is very healthy in contrast to other people her age. She feels strong mentally and physically, and has a great attitude towards the way one should live life. She should concentrate on weight management, exercising more regularly, and preventing osteoporosis by including enough calcium in her diet. She should also be sure to have regular, annual checkups such as vision and hearing checks, in addition to her normal blood work.

Subject is not happy with the way she thinks the older generation is treated by younger people or doctors even.

It would seem that the subject’s family has been predisposed to living longer lives, with the exception of her father, who was a heavy, lifelong smoker that died of cancer. So far, subject’s genetics are working in her favor.

Contrast of client’s responses with findings in current literature

· Subject is extremely healthy in contrast to other people her age. “Almost 50% of the population older than 65 have osteoarthritis, 40% has hypertension, 33% has chronic heart disease, and more than 25% suffer from hearing impairment” (Barker, 2007, p. 177).

· On average, seniors visit a physician nine times a year (Barker, 2007, p. 177). My subject has annual visits and is only seen, otherwise, if she is sick.

· Vision changes and hearing impairment are widespread among the older population. My subject has worn glasses her entire life but does not suffer from cataracts or glaucoma, and has not experienced any hearing loss to date.

Appendix B

Appendix C

INHOMESSS assessment

References:

Barker, L. R., Burton, J. R., Zieve, P. D., & Fiebach, N. H. (2007). Barker, Burton, and Zieve's

principles of ambulatory medicine. [electronic resource]. Philadelphia, PA: Lippincott Williams & Wilkins, c2007.

Katz Index of Independence in Activities of Daily Living (ADL). (2007). Urologic

Nursing, 27(1), 93-94.

15. TRUNK Marked sway or uses walking aid 0

No sway – but flexion of knees or back,

or spreads arms out while walking

1

No sway, no flexion, no use of arms, and

no use of walking aid

2 2

16. WALKING STANCE Heels apart 0

Heels almost touching while walking 1 1

SCORE – GAIT 13

SCORE – BALANCE 15

SCORE – BALANCE AND GAIT 29

Rate 1 Rate 2 Rate 3

Date of Assessment Assessor Signature and Title Location of Subject During Assessment

1.Jan 01, 2018 Paige Shinn Home

2

3

TINETTI ASSESSMENT TOOL: BALANCE

Subject’s Name: Pam Browning

Initial Instructions: Subject is seated in a hard, armless chair. The following maneuvers are tested.

Task Description of Balance Possible Score Date Score Date Score Date

1. SITTING BALANCE Leans or slides in chair 0

Steady, Safe 1 1

2. ARISES Unable without help 0

Able, uses arms to help 1

Able without using arms 2 2

3. ATTEMPTS TO ARISE Unable without help 0

Able, requires >1 attempt 1

Able to rise >1 attempt 2 2

4. IMMEDIATE STANDING

BALANCE (first 5 seconds)

Unsteady (swaggers, moves feet, trunk

sway)

0

Steady but uses walker or other

support

1

Steady without walker or other support 2 2

5. STANDING BALANCE Unsteady 0

Steady but wide stance (medical heels

4 inches apart) and uses cane or other

support

1

Narrow stance without support 2 2

6. NUDGED (subject at max

position with feet as close together

as possible, examiner pushes

lightly on subject’s sternum with

palm of hand 3 times.)

Begins to fall 0

Staggers, grabs, catches self 1

Steady 2 2

7. EYES CLOSED (at max

position – see #6 above)

Unsteady 0

Steady 1 1

8. TURNING 360 DEGREES Discontinuous steps 0

Continuous Steps 1

Unsteady (grabs, swaggers) 0

Steady 1 1

9. SITTING DOWN Unsafe (misjudged distance, falls into

chair)

0

Uses arms or not a smooth motion 1

Safe, smooth motion 2 2

BALANCE SCORES: 15

Rate 1 Rate 2 Rate 3

Date of Assessment Assessor Signature and Title Location of Subject During Assessment

1. Jan 01, 2018 E. Paige Shinn Home

2

3

TINETTI ASSESSMENT TOOL: GAIT

Subject’s Name: Pam Browning

Initial Instructions: Subject stands with examiner, walks down hallway or across the room,

first at “usual” pace, then back at “rapid, but safe” pace (using usual walking aids).

Task Description of Balance Possib

le

Score Date Score Date Score Date

10. INITIATION OF GAIT

(immediately after told to “go”)

Any hesitancy or multiple attempts to

start

0

No hesitancy 1 1

11. STEP LENGTH & HEIGHT RIGHT swing foot does not pass left

Stance foot with step

0

RIGHT foot passes left stance foot 1 1

RIGHT foot does not clear floor

completely with step

0

RIGHT foot completely clears floor 1 1

LEFT swing foot does not pass right

stance foot with step

0

LEFT foot passes right stance foot 1 1

LEFT foot does not clear floor

completely with step

0

LEFF foot completely clears floor 1 1

12. STEP SYMMETRY RIGHT AND LEFT step length not equal

(estimate)

0

RIGHT AND LEFT step appear equal 1 1

13. STEP CONTINUITY Stopping or discontinuity between steps 0

Steps appear continuous 1 1

14. PATH (estimated in relation to

floor tiles, 12 inch diameter.

Observe excursion of 1 foot over

about 10 feet of the course)

Marked deviation 0

Mild/moderate deviation or uses

walking aid

1 1

Straight without walking aid 2 2