National League of NursingNational League of Nursing

The Voice of Nursing Education

Materials

ACE.S-header
                                                         ACE-S-logo

Assessment of Older Adults in Long-Term Care Settings

Printer friendly version of this teaching strategy

Materials 

1.  Learning Activity: SPICES - An Overall Assessment Tool 

A.  This framework for assessing older adults provides a snapshot of clients’ overall health. It focuses on six common conditions: sleep problems, problems with eating and feeding, incontinence, confusion, evidence of falls, and skin breakdown. More specific assessments occur in the following learning activities. 

Tool - Video

2.  Learning Activity: Cognitive Assessment 

A.  The Mini-Cog is a brief (three-minute) screening tool can be used effectively to identify dementia. The tool is composed of three item recall and the Clock Drawing Test. Administration and scoring directions are clear and concise. 

Tool - Video

3.  Learning Activity: Geriatric Depression Scale 

A.  This short-form screening tool takes five to seven minutes to complete. Depression is under-recognized in older adults, especially those with chronic health problems. Differentiating between depression and the frustrations faced by older adults as they deal with the challenges of aging is key to providing adequate care for this age group. Recognizing depression is the first step in treatment. 

Tool - Video

4.  Learning Activity: Braden Scale for Predicting Pressure Ulcers 

A.  This is one of the most widely used tools for predicting development of pressure ulcers in older adults with medical conditions or cognitive impairment. The tool is used to assess risk in six subscore areas: sensory perception, skin moisture, activity, mobility, nutrition, and friction/shear. Subscores range from one (highly impaired) to four (no impairment), and are added together to determine the overall risk (the lower the score, the higher the risk).

Tool - Video

5.  Learning Activity: Hendrick Fall Risk Assessment 

A.  While designed for use in acute care settings, this assessment tool is useful in long-term care as well because the risk of falls increases proportionally with the number of pre-existing health problems and “risky” medications. This brief tool allows the nurse to focus on modifying or eliminating specific risk factors.

Tool - Video

6.  Learning Activity: Katz Index of Activities of Daily Living 

A.  The Katz Index measures a person’s self-care abilities in six categories: bathing, dressing, toileting, eating, transferring, and remaining continent. This tool can help nurses detect subtle changes in health and prevent functional decline. 

Overview
Getting Started
Suggested Reading
Assessment Tools 
Author Information