Frequently, many older clients have similar deficits as they age. Most care plans will include one or more of these problems, and it is good to incorporate this list into your psychosocial and functional assessment tools. These can become a pick list you can add to the beginning of your care plan because many of them will appear in your care plan.
E Care Diary will feature an interview with me on January 22 on helping seniors with activities of daily living . I will be expanding of what I have covered in my blog for the past few weeks, a geriatric assessment and how it helps older people function better in their environment. Tune in and ask questions on line.
Continence is a part of Activities of Daily Living. Fifteen percent to 30% of adults living in the community and almost 50% of nursing home residents are affected by urinary incontinence. The prevalence in older women is twice that of prevalence in older men. Pregnancy, childbirth, menopause, and the anatomy of a woman’s urinary tract are all factors that increase the likelihood of incontinence.
Despite the fact that incontinence is common in aging, it should never be considered a normal condition of aging. Various methods of managing and reducing incontinence have been developed, and many older persons have been assisted with incontinence so that the quality of their lives is not so greatly affected.
Because of embarrassment and worry about appearance and odor, an older person may not report incontinence unless asked directly. Incontinence can be isolating and has a major impact on quality of life. It also increases the risk of falls in older persons. Rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in falls and fractures. The development of incontinence is often the final factor influencing family caregivers to institutionalize those they care for.
Today we are going to again cover activities of daily living. Why? Because I have been blogging about a geriatric assessment and we are now covering a functional assessment. This is the second part of a geriatric assessment, with the first part a psychosocial assessment, which you can review in former blogs.
The term Activities of Daily Living was coined in 1949 by Edith Buchwald in Physical Therapy Review
In 1950 Katz and colleagues came up with scale in Cleveland at Benjamin Rose Hospital and designed Katz scale
Designed 6 indexes
v Feeding- late loss
v Continence- late loss
v Transferring- late loss
v Toileting early loss
v Dressing –early loss
v Bathing – early loss
Today we are covering mobility
q As a geriatric care manager, you are looking for
q Ability to transfer
q Joint function
Early detection of mobility problems and assistive devices, rehab prevent falls
Ø Observation- watch him/her walk, get up out of chair, listen to talking for clarity cognitive problem (not making sense)
Ø Ask caregiver or family member to confirm if cognitively impaired
Ø Reframe question say “ Did you drive here” instead of “ Are you still driving?”
Ø 30% of older adults living at home fall each year- makes them at risk for nursing home placement
Ø Ask them to get you a drink of water (you can watch them get out of chair and walk)
Ø Observe the older person sitting balance, transfer from supine to sitting, and sit to chair sit to stand
Ø If in bed watch transfer from one surface to another
Ø Ask client if they have shoulder pain
Ø Ask them to lift and rotate each arm
Ø As the client to two of the GCM’s fingers – measure grasp
Ø Ask client to pick up small object like toothbrush, penny, and spoon- measuring dexterity
Ø 1-5 older adults have a gait disorder, which is an excellent reason to administer the activities of daily living test.
Ø More on this tomorrow