Assessing and Planning Care for an Elderly Person

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Patient Questionnaire Summary

The interviewed patient is a 71-year old Hispanic female residing alone in a suburban area in her house but maintains strong close relationships with her children’s families. In terms of health-related beliefs, longevity is perceived as a fate-given and something characteristic to the family. Concerning the health history and current condition, the patient reports having a history of sight problems due to impaired vision, which she has experienced for several years. She broke her arm five years ago and underwent a long, challenging rehabilitation. At present, the patient reports having osteoporosis that causes back and knee pain regularly. The patient has been recently experiencing prediabetes symptoms, including tiredness, blurred vision, and continuous thirst. Diabetes is a matter of patient concern due to the family history of this illness. The prescribed medications for osteoporosis are ineffective and do not fit the patient.

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In terms of habits and lifestyle practices, the patient smokes and thinks that smoking helps reduce pain in the back due to osteoporosis. Also, she believes in the influence of mood on overall well-being, so she tries to maintain a positive attitude to life by enjoying little things, such as tasty meals. The patient states that eating a lot of sweet food helps her improve her mood and avoid depression. The interviewee does not participate in health promotion activities but goes for a walk in the park once or twice a week with her friends.

The patient confirms being prescribed Actonel for treatment and prevention of osteoporosis. However, she does not take medicine regularly due to side effects. When the illness causes pain, the patient takes painkillers. The patient exercised when she was younger and believes that sports help her remain healthy. However, now she does not exercise regularly due to health conditions. She admits to being unable to do the exercises she used to do when she was younger. The patient does not wear glasses on a regular basis due to inconvenience. She uses them to read, knit, paint, and watch TV. All other household-related and outdoor activities are performed without glasses despite impaired vision. The data obtained during the interview will be a valuable source of information that will be integrated into the analysis of assessment results.

Assessment

After receiving permission from the patient, several assessment tools have been used to identify the current mental and physical condition of the patient, as well as the safety of her home. The Tinetti Balance and Gait Evaluation was conducted, and a high level of fall risk has been identified (Table 1).

Table 1.

Tinetti Performance Oriented Mobility Assessment (POMA) Date Date Date Date
Balance Tests: Subject is seated on hard, armless chair
SITTING BALANCE
Leans or slides in chair =0, Steady, safe =1
1
ARISES
Unable without help =0; Able, uses arms =1, Able without using arms = 2
1
ATTEMPTS TO RISE:
Unable w/o help=0; Able, requires > 1 attempt =1; Able in 1 attempt =2
1
IMMEDIATE STANDING BALANCE (first 5 seconds)
Unsteady (sway/stagger/feet move)=0; Steady, w/ support =1;Steady w/o support =2
2
STANDING BALANCE
Unsteady =0; Steady, stance > 4 inch BOS & requires support =1;
Narrow stance, w/o support =2
1
STERNAL NUDGE (feet close together)
Begins to fall =0; Staggers, grabs, catches self =1; Steady =2
1
EYES CLOSED (feet close together)
Unsteady =0; Steady =1
0
TURNING 360 DEGREES
Discontinuous steps =0; Continuous steps =1
1
TURNING 360 DEGREES
Unsteady (staggers, grabs) =0;Steady =1
1
SITTING DOWN
Unsafe (misjudges distance, falls) =0;Uses arms, or not a smooth motion =1;
Safe, smooth motion =2
2
BALANCE SCORE TOTAL 11/16 /16 /16 /16
GAIT INITIATION (immediate after told “go)
Any hesitancy, multiple attempts to start =0; No hesitancy =1
0
STEP LENGTH
R swing foot passes L stance leg =1; L swing foot passes R =1
1
FOOT CLEARANCE
R foot completely clears floor =1; L foot completely clears floor =1
1
STEP SYMMETRY
R and L step length unequal =0; R and L step length equal=1
0
STEP CONTINUITY
Stop/discontinuity between steps =0; Steps appear continuous =1
1
PATH (excursion)
Marked deviation =0; Mild/moderate deviation or use of aid =1; Straight without device=2
2
TRUNK
Marked sway or uses device =0; No sway but knee or trunk flexion or spread arms while walking =1; None of the above deviations=2
1
BASE OF SUPPORT
Heels apart =0; Heels close while walking =1
1
GAIT SCORE TOTAL 7/12 /12 /12 /12
ASSISTIVE DEVICE
TOTAL SCORE (BALANCE + GAIT)
FALL RISK
(minimal >23, Mod. 19-23, High < 19)
18/28 /28 /28 /28
Therapist initials

Source: “Tinetti Assessment Tool,” n. d.

The utilization of the Katz Index of Activities of Daily Living demonstrated that the patient is highly independent (Table 2).

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Table 2.

ACTIVITIES INDEPENDENCE
(1 point)
NO supervision, direction or personal assistance
DEPENDENCE
(0 points)
WITH supervision, direction, personal assistance or total care
BATHING
Point: _1_____
(1 POINT) Bathes self completely or needs help in bathing only a single part of the body such as the back, genital area, or disabled extremity. (0 POINT) Needs help in bathing more than one part of the body getting out of the tub or shower. Requires total bathing.
DRESSING
Point: 1 ______
(1 POINT) Gets clothes from closets and drawers and puts on clothes and other garments complete with fasteners. May have help tying shoes. (0 POINTS) Needs help with dressing self or needs to be completely dressed.
TOILETING
Point: 1______
(1 POINT) Goes to toilet, gets on and off, arranges clothes, cleans genital area without help. (0 POINTS) Needs help transferring to the toilet, cleaning self or uses bedpan or commode.
TRANSFERRING
Point: 1 ______
(1 POINT) Moves in and out of bed or chair unassisted. Mechanical transferring aides are acceptable. (0 POINTS) Needs help in moving from bed to chair or requires a complete transfer.
CONTINENCE
Point: 1 ______
(1 POINT) Exercises complete self control over urination and defecation. (0 POINTS) Is partially or totally incontinent of bowel or bladder.
FEEDING
Point:1 ______
(1 POINT) Gets food from plate into mouth without help. Preparation of food may be done by another person. (0 POINTS) Needs partial or total help with feeding or requires parenteral feeding.
TOTAL POINTS= __6___ 6 = High(patient independent) 0 = Low (patient very dependent)

Source: “Katz Index of Independence in Activities of Daily Living,” n. d.

The assessment of home safety was conducted and several problematic issues have been identified. In particular, the furnishing of the house is obstructing free passing. Many carpets and high thresholds might be considered as significant obstacles for safe walking and constitute a high risk of falling. Finally, the score obtained upon the assessment according to Barthel Index is 70, which indicates the patient’s independence.

Assessment Results Interpretation and Intervention Recommendations

The results of the interview and assessment demonstrate a typical aging pattern in the patient. The interviewed woman’s ease of movement has significantly decreased as it commonly occurs in the older adults. The cognitive and memory qualities became worse with more frequent forgetting and less successful attempts to learn something new. The number of chronic illnesses increased with years, while injuries and treatment require longer recovery time. Skin becomes thinner and more likely to be damaged, as well as bones become weak and vulnerable. These issues are standard for the aging process and are easily identifiable in the interviewee. However, although the research findings indicate that human motor functions significantly decline with age, the interviewee reported active knitting and painting practices on a regular basis (Gill et al., 2018). The patient reports knitting fast and being able to paint difficult pictures that require precision. This indicates that her motor functions are in good condition, unlike commonly observed features.

Thus, there are several preliminary issues related to age-specific changes that have been identified and compared. Firstly, cognitive and memory function quality declines; secondly, movement such as walking, standing up, or sitting becomes challenging and slow. Thirdly, the number of chronic illnesses grows; fourthly, the skin and bones become fragile. Finally, since the patient experiences several chronic conditions and scores high in fall risk, these features demonstrate vivid aging changes.

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The following alterations in health might be identified based on the assessment. Firstly, the patient experiences prediabetes symptoms, manifested through blurred vision, thirst, and tiredness. Despite the risk of developing diabetes due to the family history with the illness, the patient fails to adjust her lifestyle and dieting (Sjoblad, 2019). She frequently consumes sugar-containing products and does not exercise regularly. Secondly, the patient has osteoporosis that causes her pain and knee pain. The patient does not take medication for the illness but takes painkillers. Thirdly, the patient has a harmful smoking habit. Older adults with smoking habits have a shorter life expectancy and have a higher risk of obtaining cancer and cardiovascular disease (Serrano‐Alarcon et al., 2019). It diminishes her health condition and minimizes the chances of successfully eliminating risks associated with other chronic illnesses.

Several comprehensive interventions might be introduced to address these alterations. The patient might improve her current condition related to prediabetes by consulting with a dietitian to design a dieting program excluding harmful products. In addition, the patient should be referred to an ophthalmologist for vision correction or treatment. Regular physical activities should be initiated, which might be aided by smartphone applications with reminders and guidance. Finally, health apps should be encouraged to monitor blood glucose levels and lifestyle adjustment options for patients at risk of diabetes. The osteoporosis issue should be addressed by the prescription of effective medication capable of improving bone structure and reducing pain. Alternative pain relief interventions such as meditation or aromatherapy should be introduced. Since the interviewee struggles with osteoporosis pain and diminished vision, the home safety level should be increased by replacing furniture and carpeting; assisting walking tools should be encouraged. The patient’s smoking habit should be ceased using effective practices, such as physician consultation, nicotine replacement therapy, pharmacotherapy, and cognitive-behavioral counseling.

When implementing the recommended interventions for each health alteration, cultural considerations should be applied. Since the patient is Hispanic, Latino-specific cultural beliefs and values should be applied. In particular, such issues as underinsurance, increased risk for Type-2 diabetes, and language barriers should be incorporated. In addition, traditional food should be included in the diet, as well as religious beliefs might be integrated into the therapy sessions for smoking cessation.

References

Gill, J. F., Santos, G., Schnyder, S., & Handschin, C. (2018). PGC‐1α affects aging‐related changes in muscle and motor function by modulating specific exercise‐mediated changes in old mice. Aging Cell, 17(1), 1-13.

Serrano‐Alarcon, M., Kunst, A. E., Bosdriesz, J. R., & Perelman, J. (2019). Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries. Addiction, 114(6), 1076-1085.

Sjoblad, S. (2019). Could the high consumption of high glycaemic index carbohydrates and sugars, associated with the nutritional transition to the Western type of diet, be the common cause of the obesity epidemic and the worldwide increasing incidences of Type 1 and Type 2 diabetes?. Medical Hypotheses, 125, 41-50.

Katz Index of Independence in Activities of Daily Living. (n. d.). Web.

Tinetti Assessment Tool. (n. d.). Web.

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NursingBird. (2022, June 19). Assessing and Planning Care for an Elderly Person. Retrieved from https://nursingbird.com/assessing-and-planning-care-for-an-elderly-person/

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NursingBird. (2022) 'Assessing and Planning Care for an Elderly Person'. 19 June.

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NursingBird. 2022. "Assessing and Planning Care for an Elderly Person." June 19, 2022. https://nursingbird.com/assessing-and-planning-care-for-an-elderly-person/.

1. NursingBird. "Assessing and Planning Care for an Elderly Person." June 19, 2022. https://nursingbird.com/assessing-and-planning-care-for-an-elderly-person/.


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NursingBird. "Assessing and Planning Care for an Elderly Person." June 19, 2022. https://nursingbird.com/assessing-and-planning-care-for-an-elderly-person/.