Assessments and Best Practices in Care of Older Adults

Caring for older adults is far more complex than the majority of today's nurses and other healthcare providers ever learned in school, and than the majority of faculty in any schools of nursing are prepared to teach their students. In fact, lack of knowledge about care of older adults among the teachers, students and working graduates of nursing programs results in inadequate assessment skills-skills that are the foundation of good geriatric care---and ultimately in missed or erroneous diagnoses, treatments that can harm rather than heal, and a reduced quality of life among those 65 years of age and older.

In order to provide resources that will help to fill the gap between knowledge and practice in the care of older adults, the John A. Hartford Foundation has funded the Hartford Institute for Geriatric Nursing (HIGN) at New York University's College of Nursing, and the American Journal of Nursing, for a project called How to Try This. How to Try This is an initiative that will translate the evidence-based geriatric assessment tools in the HIGN Try This assessment series into cost-free, web-based resources including demonstration videos and a corresponding print series featured in the AJN.

Why is assessment of older adults so important? Illnesses in older people often look different than in younger ones. For instance, younger adults with a urinary tract infection will have many or all of these symptoms: frequent urination, pain from bladder spasms, blood in the urine, and fever. Changes that occur with aging often mask these symptoms that provide early clues to a urinary tract infection. The first sign of a urinary tract infection in an older adult might be confusion or a fall. If the nurse does not have the knowledge and skills to further evaluate the older adult who might fall or become confused, the infection can go untreated and result in overwhelming infection, and possibly death.

Age-appropriate assessments: the foundation for good care of older adults

Assessment has long been recognized as the most important step in determining appropriate care. The Scope and Standards of Gerontological Nursing Practice establishes the professional standards, required nursing knowledge, and the specific nursing skills and abilities against which gerontological nurses are held professionally and legally responsible. These standards define assessment as the first step in managing patients and the basis for developing a comprehensive plan of care.

Good assessment leads to all subsequent care and requires that nurses know:

  • on whom assessments should be conducted
  • when to conduct the assessment
  • how to conduct the assessment
  • how to interpret the assessment
  • how to communicate the findings to the patient, family, and other members of the healthcare team
  • how to use the findings to shape the plan of care.

The links below will take you to the videos and articles specific to each topic. Videos can be watched in their entire format, or in chapters that relate to the specific assessment skills described above. Articles may be printed and copied for educational use without copyright fees.

Videos and Articles 
 
  SPICES: An overall assessment tool -- October 2007

  Fulmer SPICES -- October 2007
  GDS Short Form Assesment -- October 2007

  The Geriatric Depression Scale -- October 2007
  The Braden Scale -- November 2007 

  Predicting Pressure Ulcer Risk -- November 2007
  The Hendrich II Fall Risk Model -- November 2007

  Predicting Patient Falls -- November 2007
  The Mini-Cog -- December 2007 

  The Mini-Cog -- December 2007
  Recognition of Dementia -- January 2008  

  Recognition of Dementia in Hospitalized Older Adults -- January 2008
  Delirium -- January 2008

  Detecting Delirium -- January 2008

  Delirium Superimposed on Dementia -- January 2008
  Assessing Nutrition in Older Adults -- February 2008

  The Mini Nutritional Assessment -- February 2008
  Preventing Aspiration in Older Adults with Dysphagia -- February 2008

  Preventing Aspiration in Older Adults with Dysphagia -- February 2008
  Avoiding Restraints -- March 2008

  Avoiding Restraints in Patients with Dementia -- March 2008
  Communication Difficulties -- March 2008

  Communication Difficulties in Hospitalized Older Adults with Dementia -- March 2008
  Katz Index of Independence -- April 2008

  Monitoring Functional Status of Hospitalized Older Adults -- April 2008
  The Lawton Daily Living Scale -- April 2008

  The Lawton Instrumental Activities of Daily Living Scale -- April 2008
  The Pittsburgh Sleep Quality Index -- May 2008

  Evaluating Sleep Quality in Older Adults -- May 2008
  Pain Assessment in Older Adults -- June 2008

  Using Pain-Rating Scales with Older Adults -- June 2008

  Pain Assessment in People with Dementia -- July 2008
  Older Adult Sexuality: A Continuing Human Need -- July 2008

  Assessment of Sexual Health in Older Adults -- July 2008
 

  The Edinburgh Feeding Evaluation in Dementia Scale -- August 2008
 

  The Hospital Admission Risk Profile -- August 2008
  Assessing Family Preferences for Participation in Care in Hospitalized Older Adults -- September 2008

  The Family Preferences Index -- September 2008
  The Modified Caregiver Strain Index -- September 2008

  The Modified Caregiver Strain Index -- September 2008
  Wandering in Hospitalized Older Adults -- October 2008

  Wandering in Hospitalized Older Adults -- October 2008
  Working with Families of Hospitalized Older Adults with Dementia -- October 2008

  Working with Families of Hospitalized Older Adults with Dementia -- October 2008
  Horowitz Impact of Event Scale – Revised -- November 2008

  The Impact of Event Scale-Revised -- November 2008
  The Short Michigan Alcohol Screening Instrument – Geriatric Version (SMAST-G) -- November 2008

  Screening for Alcohol Use and Misuse in Older Adults -- November 2008
  Brief Evaluation of Executive Dysfunction -- December 2008

  Screening Older Adults for Executive Dysfunction -- December 2008
  Elder Mistreatment Assessment -- December 2008

  Screening for Mistreatment of Older Adults -- December 2008
  The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults -- January 2009

  Monitoring Medication Use in Older Adults -- January 2009
  Transient Urinary Incontinence in Older Adults -- February 2009

  Assessment of Transient Urinary Incontinence in Older Adults -- February 2009
 

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