Health Assessment of Older Adults
- Why Health Assessment of Older Adults is Important
- Defining “Quality of Life”
- Comprehensive Geriatric Assessment
- Assessing Physical Functions
- Assessing Mental Functions
- Assessing Psychological Functions
- Social Assessment
- Older Adults and Driving
- Health Assessment Resources
Each year, thousands of older Americans suffer from the deterioration of physical and cognitive skills as a consequence of aging. The decline of these skills can have a negative impact on the social and psychological aspects of an older adult’s life. It is a good idea for older adults to evaluate the major aspects of their health and well-being as it pertains to their quality of life.
- Health assessments can help older adults identify several aspects of their health and well-being that impacts their daily lives.
- The average health assessment.
- Older adults should work with their healthcare provider to create a road map for managing and treating age-related maladies.
- A comprehensive geriatric assessment provides a more thorough picture for those facing the prospect of nursing home care.
Why Health Assessment of Older Adults is Important
Health assessments allow caretakers and healthcare providers to evaluate the overall health and well-being of their charges, with the overall goal of encouraging and promoting independent function and general wellness. Assessments are usually carried out at various sites of care, including the home, hospital, doctor’s office and assisted living facility.
Health care providers begin the process by asking a series of screening questions pertaining to areas of health and function. Any potential problems that are found during the process are investigated further with a more complete evaluation. Answers to these questions should be based on the impact one’s current state of health has on their daily routine. In most cases, a family member, caretaker or someone who is familiar with the daily functioning of a loved one should be on hand to provide or verify much of the information given.
The importance of the health assessment can’t be stated enough. Taking stock of one’s quality of life and well-being allows seniors and their family members to make conscious decisions that impact their lives in a positive and fulfilling manner.
Defining “Quality of Life”
Most people use the term “Quality of Life” as a general description of one’s overall health and well-being and their ability to function under normal circumstances. This term generally encapsulates all of the various aspects of mental, physical, social and psychological function. Nevertheless, many people have their own definition of quality of life as it personally impacts their ability to perform and maintain their daily routine. For many older adults, quality of life may be linked to maintaining mobility, mental acuity or pain management.
To better deliver quality care to older patients, health care providers may inquire about quality of life via a questionnaire. This short survey covers most major aspects of senior health, giving providers and caretakers an enriched understanding of the impact an older adult’s current health state has on their life. Ensuring a positive quality of life involves talking to health care professionals, family members and caretakers about one’s expectations and wishes.
Comprehensive Geriatric Assessment
A typical health assessment does a great deal to determine an older adult’s capabilities and limitations. However, a comprehensive geriatric assessment (CGA) provides a more thorough picture of one’s social, psychological, medical and functional capacities, with the ultimate goal of creating a comprehensive road map for treatment and long-term follow up. CGAs are a staple of in-patient elder care facilities and carried out by highly trained healthcare professionals who are well-versed in treating older adults.
CGAs are effective in not only improving overall function, but also reducing the need for hospital readmission and placement in a nursing home. On the other hand, a CGA can be time consuming and expensive due to the unique requirements necessary for its success. The average CGA requires a highly trained team of health care providers, including occupational therapists and nurse clinicians, in order to accurately assess one’s current state of well-being.
Assessing Physical Functions
Assessments of physical functions are broken down into the following components:
Functional status - Functional status encompasses a wide range of day-to-day activities that are considered essential for independent living, also known as “activities of daily living” (ADL). These activities include self-care tasks (bathing, dressing and grooming), household management tasks (housework, finances and meal preparation) and mobility (climbing stairs, walking from room to room and maintaining one’s balance).
Nutrition – Malnutrition is often associated with a number of age-related chronic diseases. During an assessment, healthcare professionals always examine their patients for signs of malnutrition, which is often the result of financial hardship, medical illness, depression and the inability to shop, cook and feed oneself. Healthcare providers use the body mass index (BMI) to detect unintentional weight loss and other potential signs of poor nutrition.
Vision – Older adults tend to develop eye problems as they age. Age-related diseases like cataracts, glaucoma and macular degeneration can develop over time, making both forward and peripheral vision difficult. Assessments of eye function usually include simple eye tests (such as reading a short passage from a magazine or newspaper) and standardized eye tests.
Hearing - Hearing loss is yet another common factor of aging and one that can exact a heavy social and psychological toll on older adults. High-frequency hearing loss, common among older adults, makes consonants and other high-frequency sounds harder to hear. Those suffering from hearing loss often have a hard time understanding others, especially in noisy rooms. Hearing assessments through simple hearing tests and the use of an audioscope are usually done after removing any wax buildup present in the ear canal.
Assessing Mental Functions
Older adults tend to develop problems with memory and mental acuity as they age. According to recent statistics, the number of older adults who have issues related to thought and memory double every five years beyond age 65, with over half of older adults suffering from mental difficulties by age 90. These problems often manifest themselves in the form of accidents, missed appointments and medication, delirium and overall disability.
Many older adults are reluctant to admit problems with memory and mental acuity, which makes health assessments targeting mental difficulties absolutely important. Health care providers usually assess mental function via simple questions regarding memory and mental health, with an aim towards investigating serious signs of age related mental difficulty:
Memory – Health care providers may screen for memory loss through the use of simple memory tests. Any result other than perfect recall may require a more extensive formal test that evaluates visual-spatial skills, as well as language, attention, calculation and word recall.
Executive function – Health care providers may also evaluate a senior’s ability to change behavior in changing situations, plan and schedule actions and perform other types of executive function. The inability to perform the above usually signals the need for further testing and evaluation.
Assessing Psychological Functions
Older adults are at greater risk of suffering from some form of depression, usually due to the loss of a loved one or worries that come from aging. According to statistics from the Centers for Disease Control, those suffering from depression are likely at an increased risk of physical disability. Also, older adults who show symptoms of depression tend to recover more slowly from broken bones and other debilitating events.
Depression is not a normal part of aging. Health care providers often ask patients one simple question: “Do you often feel sad or depressed?” If the answer is yes, health care providers will further investigate the possibility of depression and help patients work toward ways of combating it.
The average social assessment focuses on the makeup of an older adult’s social network and more importantly, their ability to receive support when needed and help during an emergency. Aspects of a social assessment include:
- Determining the need for a caregiver and the type of help set caregivers should provide on a regular basis.
- Assessing the availability of family and friends for personal support.
- Determining one’s financial health and stability.
- Investigating the possibility of elder abuse and other mistreatment.
- Advanced directives, such as a living will or durable power of attorney for healthcare.
Older Adults and Driving
For many older adults, driving is both considered a necessity and a sign of independence. In many areas, cars are often the only source of transportation for older adults. Nevertheless, a wide variety of age-related factors often place older adults at greater risk of being involved in a car accident. Drivers over the age of 65 have a greater number of crashes per mile driven plus a greater chance of death or serious injury during a crash, despite spending less time behind the wheel.
Age-related changes such as decreased vision, decreased range of motion and poor hand/foot coordination often lead to slower reaction times and an increased chance of accidents. Medications for age-related illnesses and maladies can also reduce overall alertness and otherwise interfere with an older adult’s ability to drive safely. Those suffering from problems with memory and mental acuity are also at a much greater risk of being involved in a serious accident.
Part of the health assessment process also includes determining one’s ability to drive in a safe manner. In most states, health care providers and family members are encouraged, and in some cases required, to report any concerns they have about an older adult’s ability to drive. Alternative forms of transportation such as paratransit or reliance on family members may also be discussed as part of the health assessment process.
The decision to stop driving should never be taken lightly, since a voluntary or involuntary forfeiture of driving privileges often leads to a decrease in activity as well as an increased chance of developing depression. Those who are concerned about the ability of a loved one or their own ability to safely operate a motor vehicle should consult a skilled occupational therapist. In most cases, the occupational therapist will conduct a formal driving evaluation to gauge an older adult’s driving capability and offer alternatives whenever needed.
Health Assessment Resources
The following resources provide additional benefits for families and caregivers interested in assessing the health and well-being of their loved ones and charges:
AGS Foundation for Health in Aging
40 Fulton Street, 18th Floor
New York, NY 10038
National Association of Professional Geriatric Care Managers
3275 West Ina Road, Suite 130
Tucson, AZ 85741-2198
National Clearinghouse for Long Term Care Information
Administration on Aging
One Massachusetts Avenue NW
Washington, DC 20001
601 E Street, NW
Washington DC 20049