NURS 6540: Advanced Practice Care of Frail Elders | Week 2

As patients age, they are more likely to develop health issues. While some of these health issues are normal changes due to aging, some of them are abnormal and require further evaluation. Consider a 92-year-old patient who has been diagnosed with several disorders, including obstructive sleep apnea, hypertension, mild chronic anemia, restless leg syndrome, and osteoporosis. Despite these disorders, he can independently perform all basic activities of daily living, walk a quarter mile without difficulty, and pass functional and cognitive assessments. However, he did report that he fell a few times and had lost his way while driving to a familiar location (Carr & Ott, 2010). As an advanced practice nurse caring for geriatric patients, you will likely encounter patients like this. While he can pass the basic assessments, the report of falls and confusion might indicate underlying issues of immobility, sensory deprivation, and/or cognitive dysfunction that require further attention. To identify these potential underlying issues and distinguish between normal and abnormal changes due to aging, health care providers use a variety of assessments. These assessments are key tools in the care of geriatric patients. Case Study: Elderly Patient with Depression

This week, you examine assessment tools and evaluation plans used to assess geriatric patients presenting with potential issues of immobility, sensory deprivation, and cognitive dysfunction. Then, you explore implications of normal and abnormal age-related changes and consider how functional assessments are used to distinguish between these changes.

Learning Objectives – NURS 6540: Week 2: Case Study: Elderly Patient with Depression

By the end of this week, students will:

• Evaluate assessment tools used to assess geriatric patients
• Design an evaluation plan for patient with immobility, sensory deprivation, or cognitive dysfunction
• Analyze implications of age-related changes in geriatric patients*
• Analyze the use of functional assessments to distinguish between normal and abnormal implications of aging*

*These Learning Objectives support assignments that are assigned this week, but due in Week 4.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Resnick, B. (Ed.). (2016). Geriatric nursing review syllabus: A core curriculum in advanced practice geriatric nursing (5th ed.). New York, NY: American Geriatrics Society.

• • Chapter 5, “Assessment” (pp. 36-41)

This chapter reviews essential components of the comprehensive geriatric assessment, including physical, cognitive, psychologic, and social assessment. It also emphasizes other areas of importance, such as assessing quality of life and driving concerns.

Holroyd-Leduc, J., & Reddy, M. (Eds.). (2012). Evidence-based geriatric medicine: A practical clinical guide. Hoboken, NJ: Blackwell Publishing.

• • Chapter 1, “Function and Frailty: The Cornerstones of Geriatric Assessment” (pp. 1–12)

This chapter describes frailty and provides guidelines for assessing frailty in older adults. It also examines functional impairment in older adults and identifies functional assessment tools for treating and preventing functional decline in frail older adults.

Rosen, S., & Reuben, D. (2011). Geriatric assessment tools. The Mount Sinai Journal of Medicine, New York, 78(4), 489–497.

This article identifies common conditions that impact elderly patients. It also presents assessment tools that screen for geriatric syndromes, such as hearing impairment, vision impairment, functional decline, falls, urinary incontinence, cognitive impairment, depression, and malnutrition.

Optional Resources – NURS 6540: Week 2: Case Study: Elderly Patient with Depression

Note: The following resource is highly recommended for addition to your professional library. You are encouraged to utilize this “pocket” text during your on-site practicum experiences.

Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2012). Geriatrics at your fingertips (14th ed.). New York, NY: American Geriatrics Society.

Discussion: Assessment Tools

As geriatric patients age, their health and functional stability may decline resulting in the inability to perform basic activities of daily living. In your role as the advanced practice nurse, you must assess whether the needs of these aging patients are being met. Comprehensive geriatric assessments are used to determine whether these patients have developed or are at risk of developing age-related changes that interfere with their functional status. Since the health status and living situation of geriatric patients often differ, there are a variety of assessment tools that can be used to evaluate wellness and functional ability.

For this Discussion, consider which assessment tools would be appropriate for the patients in the following three case studies:

Case Study 1Mr. Smith, age 77, reports for an annual physical examination. He says he is doing well. His only known problem is osteoarthritis. He also requests a flu shot. He takes no medications other than Tylenol for arthritis pain. When he walks into the exam room, you notice that he is using a straight cane in his right hand. When you ask about the cane, he says he began using the cane because the pain in his right hip had increased significantly over the past 6 months.

Case Study 2

Mr. Jones, a 68-year-old man, was referred to your office for a hearing evaluation. He continues to work in a printing company, although he works only part-time. He has worked at the printing company for the past 35 years. He complains that he cannot hear much of the dialogue on the television. He is accompanied by his wife, who states that her husband cannot hear her at home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen impactions removed from both ears in the past. Overall, his medical history is quite benign. His only medications are aspirin 81 mg daily, a multivitamin daily, and occasional ibuprofen for back pain.

Case Study 3

Mrs. Roberts, an 83-year-old widow, is brought to the office by her daughter. The daughter claims that her mother seems to be depressed. There is a history of depression approximately five years ago, shortly after Mrs. Roberts’ husband died. At that time, she was successfully treated with antidepressants. Currently, the daughter states that her mother’s memory for appointments and events has declined severely, and she can no longer drive because she does not remember the route to the store or other familiar places. The daughter also noted that her mother’s house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and the checkbook had not been balanced for several months. Mrs. Roberts appears slightly disheveled, she has a flat affect, and she does not maintain eye contact during your interview.

To prepare:

• Review the Rosen and Reuben article in this week’s Learning Resources. Consider how assessment tools are used to evaluate patients.
• Select one of the three case studies. Based on the provided information, think about a possible patient evaluation plan. As part of your evaluation planning, consider where the evaluation would take place, whether any other professionals or family members should be present, appropriate assessment tools and guidelines, and any other relevant information you may wish to address.
• Consider whether the assessment tool you identified was validated for use with this specific patient population and if this poses issues. Think about additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.

By Day 3

Post an explanation of your evaluation plan for the patient in the case study you selected and explain which type of assessment tool you might use for the patient. Explain whether the assessment tool was validated for use with this patient’s specific patient population and whether this poses issues. Include additional factors that might present issues when performing assessments, such as language, education, prosthetics, missing limbs, etc.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Suggest alternative assessment tools and explain why these tools might be appropriate for your colleagues’ patients.
• Recommend strategies for mitigating issues related to use of the assessment tools your colleagues discussed.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6540: Week 2: Case Study: Elderly Patient with Depression.