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Photograph of a health professional with stethoscope assessing an older woman who is laughing; photo source: Administration on Aging, DHHS Learning Activities

Assessment Competency

Use appropriate assessments for the functional, physical, cognitive, psychological, social, and spiritual status of older adults.


Develop your Assessment Competency by completing some or all of these learning activities. Choose the ones that are the most useful to develop the knowledge and skills you need to demonstrate your Assessment Competency. You might want to explore them all, to see what resources are here for sharing with others in your work setting or community. Introductory Video for the Assessment Competency

If you prefer, you can read a transcript of the video.

Overview of Learning Activities:  The Learning Activities for the Assessment Competency are divided into three major aspects of assessment:

Learn to Perform a Functional Assessment

Watch a Presentation

Functional assessment is a high priority when working with older adults. Learn about Functional Assessment Screening of Older Adults by watching this presentation.

Picture of a quill pen writing on a paper screening tool  Print and Use a Screening Tool

After you print and examine this Functional Assessment Screening Tool for Older Adults you might want to watch the presentation again. Read about functional assessment in a gerontological nursing or other textbook.

Complete a Crossword Puzzle Picture of a crossword puzzle

Have fun with the Activities of Daily Living Crossword Puzzle.

Practice Functional Assessment

Now that you have learned the components of a functional assessment, it is time for you to practice. You could begin by performing a functional assessment on a cooperative family member or friend. Then perform functional assessments on at least three older adults, preferably three persons who have different levels of function. See what potential areas you identify for intervention for each person. (Interventions are incorporated into the following three competencies, which are addressed later in these Older Adult Focus materials: Adapting Care, Maximizing Function, and Optimal Aging). 

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Plan an In-Depth Assessment

Picture of textbooks Plan a Health History and Comprehensive Physical Assessment

You learned to take a health history and perform physical assessment in your nursing or other professional courses. This Assessment Competency adds some pieces that are specific for older adults. 

Read about performing a health history and comprehensive physical assessment in a gerontological nursing or other textbook. Then read the Tips for Geriatric Health History and Physical Assessment. Did you find some additional points that would be useful?

If possible, watch a nurse, nurse practitioner, or other health care professional perform a health history and comprehensive physical assessment on a person aged 65 or older. What would you have done differently? What did the person you observed do that you would like to incorporate in your practice? Would you like to share the Tips for Geriatric Health History and Physical Assessment?

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Practice Focused Assessments      

In many settings, we perform a focused assessment rather than an in-depth assessment. Here are some opportunities for you to practice focused assessments specific for older adults.

Picture of a stethoscope Vital Signs

As you likely know, postural hypotension is common with increasing age. On at least two older adults, obtain oral temperature and lying, sitting, and standing blood pressures. What difficulties did you encounter in obtaining these measurements? How are your findings similar or different from what you expect for a young adult? Read what a gerontological nursing or other textbook has to say about vital signs in older adults.

Oral Cavity Picture of a mouth

Oral assessment and care for older adults are sometimes neglected, which can cause major difficulties with nutrition and social interaction.

The following article most likely has a more comprehensive coverage of oral health than a textbook. We recommend it highly. Picture of two journal articles

DeBiase, C.B., & Austin, S.L. (2003, Spring). Oral health and older adults. Journal of Dental Hygiene, 77(2), 125-147.

Ask at least two older adults who take medications implicated in causing xerostomia if they are experiencing dry mouth. If so, explain the relationship between the dry mouth and the medication and ask how they manage dry mouth.

If you work in an institutional setting, assess the oral cavity of at least five older adults who need assistance with activities of daily living. Do you find evidence of need for more oral care? If provision of oral care is an issue in your setting, you may find the following article useful in understanding some of the contributing factors:

Gil-Montoya, J.A., Ferreira de Mello, A.L., Gardenas, C. B., & Lopez, I.G. (2006). Oral health protocol for the dependent institutionalized elderly. Geriatric Nursing, 27 (2), 95-101.

Picture of an eye Eyes and Ears Picture of an ear

Now is a good time for you to read (or review) the material in a gerontological nursing or other textbook about vision and hearing. Keeping in mind the sensory changes of aging that you studied in the Communication Competency, assess changes in vision and hearing in at least two older adults. How do these changes influence each person's daily life?

Picture of an eyeAn Amsler grid is used with each eye separately to test for macular degeneration. Visit the website of the Macular Degeneration Foundation, Inc. to see an Amsler grid (click Eye Test) and explore its use.

http://www.eyesight.org Picture of the letters http:

Note: The internet link provided here was active at the time these Older Adult Focus materials were prepared. If the link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Picture of an earCerumen can be a major ongoing contributor to impaired hearing in older adults. Use an otoscope to examine the ear canal of at least two older adults. What were your observations? If cerumen is routinely removed in your clinical setting, how is it done? By whom? How often? In many settings, cerumen is not assessed or removed routinely. If this is the case in your clinical setting, find out to whom you should refer if you find an older adult with excessive cerumen. Remember that the use of hearing aids can increase cerumen buildup.

Picture of an adhesive bandage Skin 

Read the material in a gerontological nursing or other textbook about skin. You will focus on pressure ulcers as you build your Adapting Care Competency, so you can leave that portion of the material until then if you wish.

On at least two older adults, assess the skin for fungal infection. As you likely know, fungus grows best in warm, moist locations. Be sure to assess the most common sites of skin fungal infection in older adults:

How would you keep these areas clean and dry, given the individual circumstances of the persons you assess?

Lungs, Picture of lungs   Cartoon of a strong, happy heart Heart,
              Picture of a foot and ankle Peripheral Circulation

Here we shall review focused assessment of four disease processes that are common in older adults.   

 Picture of lungsRead about chronic obstructive pulmonary disease (COPD) in a pathophysiology book or course materials. What assessments should you use for ongoing assessment of a person who has emphysema (Type A COPD) or chronic bronchitis (Type B COPD)? What assessment findings will alert you to the development of an acute pulmonary infection in a person who already has COPD?

Look up congestive heart failure (CHF) in a pathophysiology book or course materials to refresh your knowledge of how to assess for this condition. Think through why you should assess for each of these manifestations:

  • Sudden weight gain      
  • Fatigue   Picture of a heart that has a bandage on it
  • Dyspnea
  • Distended neck veins
  • Ankle edema (or sacral edema in a bedfast person). 

Note that older adults whose heart failure is managed on a chronic basis need to be taught to self-assess and contact their health care provider if the signs and symptoms increase over their current level.

Myocardial infarction (MI) in older adults may occur without chest pain. These silent MIs are more common in persons who have diabetes, but may also occur in older adults who do not have diabetes. Although chest pain is still the most common symptom of MI in both men and women, older women may report vague chest twinges or back pain instead of chest pain. Read about the other clinical manifestations of MI in a pathophysiology book or course materials.

Picture of a foot and ankel Finally, read about the clinical manifestations of peripheral vascular disease in a pathophysiology textbook or course materials. If you remember that the arteries carry blood into the lower extremities toward the toes and the veins return blood from the lower extremities toward the heart, you will be able to reason out which signs and symptoms indicate arterial disease and which ones indicate venous disease. As you likely know, people who have peripheral vascular disease may develop stasis ulcers (venous disease) or ulceration and gangrene (arterial disease). Impaired tissue healing occurs in both conditions. Some older adults have both arterial and venous disease, which makes assessment and management of these conditions more challenging. 
Sexuality Picture of a man and woman dancing

Read this brief overview of Sexuality and Aging. Think about your own attitudes toward sexuality and sexual expression in older adults. Read the material in a gerontological nursing or other textbook about sexuality and aging, including changes with age in the reproductive organs. In what circumstances and settings would it be appropriate to assess sexuality? How would you ask about sexual activity of a 72-year-old man? Of a 72-year-old woman? How can you assess other aspects of sexuality?

Cognitive Function  Cartoon of a person looking confused 
Cartoon of a balloon that has a sad face    and Depression

Many screening tools are available for assessing cognitive function of older adults. Screening tools are very useful in identifying possible deficits that require referral for more in-depth assessment and management. Four of these screening tools are listed below: 

Cartoon of a person looking confused

Select one of the screening tools listed above and familiarize yourself with it. If a link is not provided, look in a gerontological nursing or other textbook or search for it on the internet. Here are questions to consider:

Administer the tool you selected to an older adult in an appropriate setting. Make a referral for follow-up if your assessment indicates the need. How easy or difficult was the tool to use? 

If another screening tool for cognitive function of older adults is used in your clinical setting, practice using it until you are comfortable with it. Search the literature for an article describing its use and answer the questions that are bulleted above.

Cartoon of a balloon with a sad face

Depression is a concern for older adults in all settings. Several screening tools for depression are available for older adults. Here are two of them:

Consider your clinical setting and select one of the two screening tools listed above to investigate. If a link is not provided, look in a gerontological nursing or other textbook or search for it on the internet. Here are questions to consider:

Administer the tool to an older adult in an appropriate setting. Make a referral for follow-up if your assessment indicates the need. How easy or difficult was it to use? 

If you work with older adults whose primary language is not English, you may need the Geriatric Depression Scale in another language. The website below is your source for the Geriatric Depression Scale translated into many languages, including Spanish, Thai, Chinese, Korean, Russian, and Greek. J. A. Yesavage is one of the original developers of the scale.

J.A. Yesavage Site for Geriatric Depression Scale      

http://www.stanford.edu/~yesavage/GDS.html

Picture of the letters http:

Note: The internet link provided here was active at the time these Older Adult Focus materials were prepared. If the link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Picture of a man walking his dog Mobility Picture of two persons jogging
Picture of a man playing golf

The Get Up and Go Test is a screening assessment that should be conducted as part of a routine evaluation when dealing with older persons. Its purpose is to identify persons who need further evaluation for abnormal gait or increased risk of falling. You met the Get Up and Go Test briefly in the presentation on Functional Assessment Screening of Older Adults. Here are more complete instructions: How to Perform a Get Up and Go Test

After you read the instructions, watch these short video clips:

Note that these videos were taken in a home (first video) and the recreation room of an apartment complex (second video). Because this screening assessment does not require elaborate equipment, you can perform it anywhere you can find a 10-foot space that is safe for walking.

Now is your opportunity to become proficient in the use of this useful screening assessment. Use it on yourself. Practice it on a family member or friend. Then use it with at least two older adults. Remember that it is a screening test. Persons who have difficulty or demonstrate unsteadiness performing the Get Up and Go Test require further assessment. Make a referral for follow-up if your assessment indicates the need. 

Falling is a concern for many older adults. You will learn about falls by older adults in the Adapting Care Competency.

Bowel Function Picture of a toilet

Find a professional resource that provides recommendations for assessment for constipation, impaction, and bowel obstruction in older adults. Read the material in a gerontological nursing or other textbook about assessment of bowel function. How is bowel function assessed in your clinical setting? Do you want to share information with your colleagues?

You will find evidence-based guidelines for prevention of constipation in the Optimal Aging Competency.

Picture of a cut apple Picture of a pear growing on a tree Picture of two cherries growing on a tree
Picture of peas in the pod Nutrition
Picture of two tomatoes

                   Picture of a carton of milk

Do you remember the Quadruple A's of Nutrition from the presentation on Functional Assessment Screening for Older Adults? If not, here is your opportunity to review them. They provide a very brief nutrition screen. Assess your own nutrition using the Quadruple A's of Nutrition. Then use them to assess nutrition in at least two older adults. Make a referral for follow-up if your assessment indicates the need.

You will encounter another nutrition screening tool (DETERMINE) in the Optimal Aging Competency.

Quick Screen for Geriatric Problems

Older adults have increased risk of developing health-related problems that include sleep disorders, problems with eating, incontinence, confusion, falls, and skin breakdown. 

Photograph of three cans of spices The SPICES tool uses an acronym to help us remember these common problems. SPICES provides a quick screen that highlights areas needing more assessment.

Print the SPICES, available at http://consultgerirn.org/uploads/File/trythis/try_this_1.pdf. Practice using it with at least two older adults in an appropriate setting. Follow up on your findings if needed.

You will learn about managing these geriatric problems in the Adapting Care Competency.

Return to Functional Assessment

Practice one or two more functional assessments on older adults until you feel competent in performing this important assessment and are ready to demonstrate your assessment competency.

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After you have completed some or all of these Learning Activities, proceed to the Competency Demonstration.

Developed by C. Van Son and L. Felver; Revised 2010

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contactus@olderadultfocus.org Copyright Linda Felver and Catherine Van Son, 2006, 2011