Case Study 1:

Mr. Perkins, age 81, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he uses a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

Discussion: Evaluation Plan
As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as a nurse practitioner, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of older adult patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability. For this Discussion, you will consider which assessment tools would be appropriate for a patient in a case scenario.

To prepare:

Review this week’s Learning Resources, considering how assessment tools are used to evaluate patients.
Your Instructor will assign a case study to use for this Discussion. Review the case study and, based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments such as language, education, prosthetics, missing limbs, etc.
Consider immunization requirements that may be needed for this patient.
By Day 3
Post an explanation of your evaluation plan for the patient in the case study provided, and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, etc. Also explain the immunization requirements related to health promotion and disease prevention for the patient.

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Solution

Evaluation Plan for a Geriatric Patient

This male patient is an octogenarian aged 81 years old. He is in relatively good health judging by the fact that he is only taking Tylenol medication for his arthritic pain. This means that he does not have any comorbidities to warrant taking a plethora of medications. The main problem that he has is osteoarthritis whose pain he confesses to have increased and that is why he is walking with a cane. On this visit, he requests also for immunization against flu. This paper looks at his evaluation plan in terms of assessment tools, required immunizations, and additional factors such as language and education.

Explanation of the Evaluation Plan and Types of Assessment Tools

My evaluation plan for this octogenarian is to carry out a holistic evaluation that is not only restricted to the physical. It will cover his psychiatric status, cognitive ability, functional ability, home safety, neurologic function, pain, nutritional status, and overall health (University of Maryland, 2021).

Types of Assessment Tools to Use for the Patient

The types of assessment tools that I might use for this patient are outlined below depending on the area of interest for the assessment. They are (University of Maryland, 2021):

1. For functional ability – Global Assessment of Functioning (GAF) scale

This assessment tool will enable the evaluation of whether this patient can still perform for himself the activities of daily living (ADLs) such as bathing, feeding, and dressing.

1. For cognitive ability – Mini-Mental State Examination

This assessment tool will be crucial as it will enable the identification of any neurocognitive disorder that may not ye be apparent but present. An example is Alzheimer’s disease (APA, 2013).

• For hearing – Hearing Handicap Inventory

At the age of 81 years, it is expected that this patient has some sort of hearing problem. This assessment tool will be invaluable in determining this or otherwise.

1. For neurologic function – Abnormal Involuntary Movement Scales (AMS)

Assessment of neurologic function using this tool will also be important to rule out conditions such as stroke and Parkinsonism.

1. For home safety – Home Safety Checklist

The home safety checklist tool is another important tool to use with this patient. This is because for instance patients above the age of 65 years are at great risk of accidental falls at home and in the healthcare setting (McCarthy, 2016).

1. For mood – Geriatric Depression Scale

Elderly patients are often suffering from depression due to the fact that most of them feel lonely. This assessment tool will determine if this patient is suffering from depression or not.

• For pain – Pain Assessment

Pain assessment is important with this patient to determine the extent of his arthritic pain. He says the hip pain has increased steadily over the last six months.

• For nutritional status – Nutrition Checklist for Older Adults

Elderly patients often suffer malnutrition. Assessing for their nutritional status is a wise move as it may reveal potential malnutrition that could cause lowered immunity.

1. For psychosis – Pittsburgh Agitation Scale

Determining the psychological status of this patient is important, just because of the ramifications were there to be a psychotic condition.

1. For overall health – aging Quiz

Lastly, assessing the octogenarian’s overall health is also vital to determine where he stands in the overall scheme of things.

Validation of Tools and Accompanying Issues

All the ten tools mentioned above have been validated for use with this geriatric patient population. If this was not the case, of course, there would have been issues with the validity and reliability of the tests.

Additional Factors

The additional factors that might present issues when performing the above assessments for this patient include language barrier and level of education. Since he is not accompanied, language would present a significant barrier to communication. In the same way, the low educational achievement will present the challenge of simplifying everything for the patient to understand.

Immunization Requirements

In the case of this patient, these are (NCA, 2021):

• Influenza or flu vaccine
• Pneumococcal vaccine for pneumonia
• Shingles vaccine
• Hepatitis B vaccine

References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

McCarthy, M. (2016). Falls are leading cause of injury deaths among older people, US study finds. BMJ, 354 (i5190). https://doi.org/10.1136/bmj.i5190

National Council on Aging [NCA] (November 24, 2020). Four important vaccines for seniors covered by Medicare. https://www.ncoa.org/article/4-important-vaccines-for-seniors-covered-by-medicare

University of Maryland (2021). Geriatric assessment tools. https://www.pharmacy.umaryland.edu/centers/lamy/clinical-initiatives/medmanagement/assisted_living/geriatric-assessment-tools/