Safety for the Older Adult Response
Indeed, functional health assessment can help in the collection of key data and information from an elderly patient regarding his/her mental and physical capacity and their functioning when it comes to undertaking Activities of Daily Living (ADL) as well as Instrumental Activities of Daily Living (IADL). Activities associated with everyday functioning include eating and dressing, hygiene, elimination and mobility, IABL tend to be highly complex yet crucial in day-to-day independent functioning of the patient and they include: meal preparation, bills payment, household management, transport facilitation and use of medications. Therefore, the core purpose of conducting functional assessment is to collect vital information and data that may assist the nurse to gain a holistic understanding of an aging individual’s response to live conditions, illness and health.
There are numerous assessment methods that can be applied to determine the functional status of an individual. Whilst the Lawton scale may be common when assessing human responses to health-related issues, skin assessment may enable in-depth examination of the patient’s skin to reveal exposure to physical violence, risk for falls, neglect, nutritional status, maltreatment, and pressure ulcerations. Other tools include the Brandon Scale that is commonly employed to conduct risk assessment for pressure wound, and hence may be employed to inform the need for further assistance or a transition in care in the quest for high-quality care and support (Abeliansky et al., 2021). Palloni (2019) established that the Gordon’s Functional Health Patterns is also an effective assessment framework for arranging interview questions based on the evidence-based patterns of responses from the elderly patients and their caregivers/families.
This assessment tool explores a number of categories namely elimination, nutritional-metabolic, sleep-rest, sexuality-reproductive, value-belief, coping-stress tolerance, activity-exercise, role-relationship, health perception-health management as well as self-perception and self-concept. Finding answers to questions for all the categories may help to provide a better understanding of the functional health of a geriatric client.
Abeliansky, A. L., Erel, D., & Strulik, H. (2021). Social vulnerability and aging of elderly people in the United States. SSM – Population Health, 16, 100924. https://doi.org/10.1016/j.ssmph.2021.100924
Palloni, A. (2019). Health status of elderly Hispanics in the United States. The Health of Aging Hispanics, 17-25. https://doi.org/10.1007/978-0-387-47208-9_2
Activities of daily living are one of the best indications of functional status for a client. One assessment used to determine IADL’s in the geriatric population is the Lawton Scale of IADLS. IADLS include specific tasks such as driving, handling finances and medication management (Warshaw et al., 2021). This assessment is easy to administer and only takes between 10-15 minutes. Assessing IADL and ADLs is recommended to identify any new disabilities for the client that may affect their safety and indicate a need for additional assistance. For the Lawton Scale there are 8 categories assessed and a summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women and 0 through 5 for men (Warshaw et al., 2021). A low score score would indicate a need for further assessment and/or additional help with IADLs.
A skin assessment is another great exam to do to determine client safety. From a skin exam you can assess for tears, lesions, bruises, pressure ulcers that could reflect adequate nutrition, abuse, neglect, maltreatment, risk for falls; all of which would be a safety concern for their current environment (Warshaw et al., 2021). Areas to be sure to assess are the sacrum and heels as these are high risk areas for increased pressure ulcerations. A risk assessment tool often used for pressure wounds is the Branden Scale. The Branden Scale has 6 domains: moisture, activity, mobility, nutrition, and friction/shear that are rated on a points system from 0-23 (Warshaw et al., 2021). . Negative results such as a score greater than 18 on the Braden Scale or bruising, may indicate that the client requires additional assistance or a transition in care to another facility or home.
According to The American Geriatrics Society, transitions in care are defined as “a set of actions designed to ensure the coordination and continuity of health care as patient’s transfer between different locations or different levels of care in the same location” (Malley & Kenner, 2016). The NP’s role specifically is to develop a plan, ensuring that providers are communicating all pertinent patient information efficiently and educating both the family and the patient on the goals and barriers of the transition. The goal is the most seamless handoff possible and if done correctly, it minimizes cost, confusion, and readmissions (Dunphy, 2019). One study showed that including nurse-led home visits, that include self-care education, as part of the transitional care model was beneficial in reducing readmissions (Van Spall et al., 2019).
If my client required a transition in the care environment whether that be between hospitals or hospital to home or any other scenario, I would recommend them to a local Transitional Care Program. In the Hudson County area there is Embassy Manor, a nursing and rehabilitation center, which includes a full time interdisciplinary team of expert transitional care management members to ensure the most seamless transition possible for the client or their loved one. Another facility is Hoboken University Medical Center’s Transitional Care Unit that includes a team of skilled nursing, physical, occupational, speech and respiratory therapists (Carepoint Health, 2022). As the provider, the NP can ensure coordination of care during transitions by taking responsibility for managing the multidisciplinary transitional care team (Warshaw et al., 2021).
These facilities can cost a lot of money which is why it is important to know of places you can recommend to clients with limited resources. Sadly, it was very difficult for me to find any that were of little or no cost in Hudson County. One I identified, Robert Wood Johnson University Hospital, offers free Transitional Care services to eligible Medicare & Medicaid beneficiaries. Another, Hackensack Meridian Health’s Transitional Care Unit, offers transitional care services at a reduced rate to New Jersey residents.