Expert in Aging Life and Geriatric Care Management
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.
A functional assessment involves three goals. One is to help older person continue to function in her environment (stay at level of care)
The second goal is to help older person better function in his environment. The last goal is to find areas where he or she not functioning well –
A functional assessment involves two parts. We have already covered Activities of Daily Living. We are now going to look at Instrumental activities of daily living.
Lawton ‘s IADLs broken into 8 parts
ü telephone
ü shopping
ü food preparation
ü housekeeping
ü laundry
ü mode of transportaion
ü finances
We will now start to cover these IADLs and how the aging professional can most expertly do that section of a functional assessment of an older client.
Continence
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.
Assessing fall risk is a big part of assessing client mobility. Every year, approximately 30% of older persons living at home fall. In fact the Center for Disease Control says every year 1 in 3 older adults has a fall . Getting more information about where falls occur is vital. A practical mnemonic for reviewing the actual fall is as follows:
S ‑Symptoms experienced at the time of fall
P ‑Previous number of falls or near-falls
L ‑Location of falls
A ‑Activity engaged in or attempted at time of fall
T ‑Time (hour) of fall
T ‑Trauma (e.g., physical or psychological) associated with falls
Prevention of falls is of utmost importance because after a fall the fear of another fall can become a vicious cycle. Fear leads to inactivity that then results in decreased strength that then leads to increased risk of another fall.
Many falls by older persons occur in the bathroom, the most dangerous room in the house. Adaptations in the environment can decrease the risk. If your client is falling at night, ask about the use of sedating medications at bedtime. Or perhaps does the person fall because he or she ambulates slowly and needs to rush to answer the only phone in the home, which is located on the kitchen wall? Getting a portable telephone may decrease the risk of another fall. Was the person experiencing specific symptoms secondary to medical problems, for example, dizziness or postural hypotension? Reviewing these symptoms with the physician can result in treatment or change in medications that will reduce the risk of a repeat fall.
Changes in the environment, attention to adaptations, and medical evaluation will make it safer for a person with impaired mobility to get around the home. In addition, with the goal of improved mobility and balance, the care manager should think about the possibility of physical therapy for strength training, personal trainers who can come to the home or the assisted living facility to do light exercise, or even a membership at a local senior-friendly gym that offers tai chi classes, which are known to improve balance. In addition, for clients in nursing homes the care manager needs to advocate for needed therapies and medical evaluations to improve mobility and decrease falls.